Madam, - As a GP, I was heartened to read Dr Martin Cormican's letter of February 6th, in which a consultant acknowledges the need to develop primary care as a priority for health reform.
Historically, general practice and primary care have been under-resourced and underdeveloped in Ireland. Other countries have realised that primary care is where the majority of people's health problems are dealt with and that a well developed primary care system can reduce the burden on the hospital sector.
But things are changing. HSE chief executive Prof Drumm has spoken about primary care centres in every community where GPs, practice nurses, public health nurses, a physiotherapist, an occupational therapist and a home help co-ordinator will work in a highly integrated way looking after a defined population. If you have a chronic condition such as diabetes, asthma or heart disease, such a team can look after most of your needs in your own community. If you are an elderly person being discharged from hospital after a stroke, this team can tailor a package of care to meet your needs in an integrated way. If you suffer from stress, anxiety or depression, or need help to stop smoking, members of the team can help you.
In Prof Drumm's vision, these primary care teams will be as recognisable to the communities they serve and engender the same sense of belonging as the local GAA club. In order to achieve this, a system of universal patient registration, where every man, woman and child in the State chooses a primary care team to sign up with, will be necessary. In addition, a method of providing the physical infrastructure to house these teams to agreed standards for every community must be worked out.
The other major area for reform relates to where and how primary care and secondary care interface - currently the accident and emergency department and the outpatient department. We really must get away from the present system whereby every acute referral to hospital from primary care must be "processed" by relatively junior doctors in the hospital emergency department.
Similarly, in hospital outpatients' units, all too often the patient is seen by a relatively junior doctor who is acting completely without reference to what may be happening to the patient in primary care and tends to call the patient back for review in six months, thereby clogging an already clogged-up system.
Prof Drumm is well aware of this disconnected and fragmented service as experienced by patients and described it in detail in his speech broadcast on radio on St Stephen's Day last. I have no doubt that his prescription - to develop primary care teams and to improve the primary care/secondary care interface - is correct and I hope the resources will be made available to push through this very necessary reform. - Yours, etc,
Dr GARRETT IGOE, Virginia Primary Care Team, Virginia, Co Cavan.
Madam, - It was interesting to read Muiris Houston's piece "Making healthy forecasts" ( Health Supplement,February 6th). It is always comforting - at least for those amongst us who can afford them - to read about medical advances that, some day, will be used to treat and manage the illnesses and disabilities that might afflict us.
A recent poll conducted by the British Medical Journalasked people to identify the most important medical advance ever made. "Sanitation" topped the poll, and many of the other items in the top 10 were associated with environmental, social and behavioural developments. The Wanless report "Securing Good Health for the Whole Population" (2004) also highlighted the important role of disease prevention and public health interventions.
As a society, we should be as committed to tackling the root causes of illness and disability as we are to treating and managing them. Of course we need efficient and equitable health and social services. But we also need to create a healthier society - a society where all have access to education; a fairer and more inclusive society; a society not unduly influenced by the tobacco, alcohol, food and pharmaceutical industries; a society that truly respects the rights of minorities and protects the vulnerable.
Only if we put aside some of our fascination with technology and "quick fixes" and work towards creating a healthier society will we rein in the spiralling costs of the health and social services, and achieve that healthy future to which we all aspire. - Yours, etc,
Dr KEVIN P. BALANDA, Associate Director, Institute of Public Health in Ireland, Redmond's Hill, Dublin 2.