Health: a credible way forward

An enhanced primary care service offers a route away from the existing hospital centric system

Tthe current price of moving to a properly functioning primary care GP based system is an additional€500 million a year over a 10 year period, according to HSE director general Tony O’Brien. Photograph: Cyril Byrne

Tthe current price of moving to a properly functioning primary care GP based system is an additional€500 million a year over a 10 year period, according to HSE director general Tony O’Brien. Photograph: Cyril Byrne

 

The recently published report “A Future Together: Building a Better GP and Primary Care Service” was initially commissioned by the Health Service Executive (HSE) as an information exercise for a new GP contract. Significantly it developed into a wider look at the development of primary care as a driver of reform.

First mooted in the early days of the HSE, the current price of moving to a properly functioning primary care GP based system is an additional€500 million a year over a 10 year period, according to HSE director general Tony O’Brien. This is a substantial amount of transitional funding butit is the price that must be paid to move from our overly hospital centric system.

Produced by researchers at the Department of Public Health and Primary Care at Trinity College Dublin, the report was published a week after the Ministers for Finance and Health signalled a reversal of the FEMPI cutbacks which have held back service development in the primary care sector. In a key contribution it quotes Mr O’Brien as saying: “we need to do things that go beyond... the normal annual cycle and exploit to the greatest extent possible the fact that the current confidence and supply agreement (in Government) commits to multi-year funding...”.

This is realpolitik. The system needs substantial investment over time to safely transition from a sick service to a health service. It will involve the reallocation of funds from hospital to general practice, something the researchers found is supported by hospital consultants. It is widely accepted that too many patients are unnecessarily funnelled into secondary care. The report found that just 4.5 per cent of the entire health budget is spent on payments to GPs.

Despite increasing stresses in the sector, patients who were surveyed expressed very high levels of satisfaction with GPs and practice nurses. GP out of hours services were highly rated for accessibility. The skeleton of a good primary care service already exists. Recent reports have mapped a reasonable road to expansion. They must be acted on.