The present system of primary healthcare has some strengths and many weaknesses, the Secretary General of the Department of Health and Children said in an address to the first national conference on the primary-care strategy.
Mr Michael Kelly affirmed his commitment to the strategy, "Primary care: a new direction", in Galway yesterday. He listed the present weaknesses of primary care as: having a poorly developed infrastructure; a poor liaison between primary and secondary care; many of the services currently provided in hospitals could be delivered in primary care; out-of-hours services for patients remain underdeveloped.
Mr Kelly said the proposals for restructuring primary care had the capacity to meet up to 95 per cent of all health and personal social service needs of the population and that international evidence showed that team-based primary care is better for patients.
"We are at the beginning of a process which won't be advanced overnight. But we do have an implementation plan which takes into account the breadth of change needed".
In a reference to those who have criticised the strategy, he said that "there is no other show in town" as far as he and the Department of Health were concerned. "My mission in life is to see the implementation of the health strategy," Mr Kelly said.
The two-day conference, organised by the Department of Health and Children, brings together all stakeholders - professionals, voluntary organisations and patients - and aims to facilitate the practical implementation of new primary- care teams.
The Minister for Health, Mr Martin, recently approved the first 10 projects for funding under the primary-care strategy. Each will see the expansion of GP services to include therapists, nurses, social workers, home-care assistants and others in the first step towards the provision of a "one-stop shop" for community health care. This initial phase of primary-care development will change the way 80,000 people access healthcare and has been guaranteed funding of €8.4 million for 2002 and 2003.
The conference heard how a similiar process of primary-care reform had developed in Canada. Dr Ruth Wilson, of the Ontario Family Health Network, described the process of change from the setting-up of four pilot sites in 1998 to the formation of eight family health networks involving 250 doctors earlier this year.
A family health network is a group of at least five family doctors working together to provide team based and co-ordinated care to their patients. Among the biggest challenges faced by doctors was the acqusition and integration of information technology.
Patients of the family health networks reported improved access to primary care and a better emphasis on preventative health .
However, Dr Wilson told delegates that it requires "a strong political will to make such changes happen", and that doctors and others in the Republic can expect to meet both scepticism and cynicism during the implementation of the primary-care strategy.
Dr Philip Crowley, a GP and public health physician, presented a paper on the importance of community involvement in bringing about change in primary care.
"There is a huge amount of contact with local people by GPs and public health nurses which represents a great opportunity," he told the meeting. The advantages to involving the public included discovering new ways to tackle old problems and helping to broaden the agenda beyond a "sickness" health service. Public involvement is the key to tackling barriers to accessing healthcare for minority groups, he said.
Asked about the importance of community involvement in the primary care strategy, Dr Crowley said: "The primary-care strategy, by supporting the development of community involvement, will ensure we move beyond dealing with illness and take steps towards tackling inequalities in health between different social classes."