Far-reaching changes in general practitioner services, an additional 1,000 consultants and 5,000 nurses, and a 40 per cent increase in the number of hospital beds are expected to be included in the Government's new health strategy.
A single waiting list for public and private patients is also under consideration, the Minister for Health, Mr Martin, has indicated to the Health Strategy Consultative Forum which is advising him. He has recently set up a forum subgroup to examine short-term measures to ensure fairer access to services.
The detailed Health Strategy 2001 document is nearing completion within the Department of Health, and is due to go to the Cabinet for approval in September.
It proposes an increase of 5,000 hospital beds over a 10year period. The State's current bed complement, including public and private hospitals, is 12,500.
A support service for patients, modelled on the NHS Direct telephone advice system in the UK, has been proposed by another subgroup of the forum. Intended to offer reassurance and self-diagnosis, it would be staffed by nurses. The hope is that this could emerge as a key element in tackling the problems of inappropriate attendance at hospital accident and emergency departments.
Reform of primary healthcare is to be the cornerstone of the new seven-year strategy. The Irish Times has seen a key 40page document drawn up by experts advising the Minister which proposes major reorganisation of GP services.
Instead of the current system, under which most GPs work from their own surgeries, there would be a new network of primary care teams, based in the community and accessed by an 1850 telephone number. The teams would include not only doctors, but also nurses, social workers, therapists and other health professionals. Patients would no longer have to see their GP as the first point of contact.
The strategy is intended to tackle ever-lengthening hospital waiting lists by diverting patients into a revamped and reorganised primary health service.
The proposals are contained in a document titled Recommendations for Primary Care: Your first point of contact and your ongoing contact with the Health and Personal Social Service. It proposes the integration of social services, provided by social workers and community welfare officers, with health services traditionally provided by GPs and public health nurses.
The expanded teams would operate from central premises in each area. Patients would be encouraged to register with their local team and would be directed to the appropriate team member when they made contact with the service. Access to primary care would be based on need and not eligibility.
The authors of the document acknowledge there will be contractual issues involving individual practitioners. GPs and dentists currently operate as independent contractors and are paid on the basis of capitation and fee-per-item.
Under the new system, they would become team members servicing a defined population in a definite geographical area. The possibility of all team members becoming salaried employees has not been ruled out.
The strategy envisages an increase in the use of daycare procedures in hospitals. The intention is that 50 per cent of all acute hospital activity will be daycare, compared to 36 per cent at present.