1. Dr. David Molony MPHC Mallow 13/6/2013

2. Can Primary Care really make a difference to the Irish health service?
Role of Primary Care
Can Primary Care really make a difference to the Irish health service?

3. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

4. Primary Care (term from Dawson Report 1920 UK)
Primary Care is the first level of medical intervention—ie Pre-hospital care
Secondary Care is hospital intervention with potential overnight stay
Tertiary Care is Specialist Hospital care

5. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

6. Primary Care 2,600 GPs + 500 other GPs 280 Training Registrars
>1,200 Practice Nurses
3-4,000 administration staff
HSE pre hospital services- 4,000 PHN,
HSE Community Specialists-Physio, OT, S&L, Psychology, Podiatry etc.
HSE Administrative staff
Private Community Specialists –mirror HSE

7. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

8. General Practice Activity-currently
44% GMS (GP + HSE cover)
56% Private (no HSE cover)
21,000,000+ consultations/yr.-100% pop, >90% satisfaction.24/7, 365, same day presentation, Co-Op contribution, refer 10% hosp (½ for diagnostics), CDM.

9. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

10. Patient Pathway GP Gatekeeper role 21,000,000+ Primary Care 19,000,000
Full treatment
Secondary Care
1,000,000 diagnostics
Hosp. Stay, OPD,
Tertiary Care
Specialist services
2,000,000
19,000,000

11. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

12. Primary Care Strategy-2001
Provide 90-95% healthcare needs.
Patient centred care, near patient, community emphasis, Flexible hours.
Primary Care Teams—7-8,000 patients, co- operation, deliver care eg EARLI Study in MPHC.
Ease pressure on hospitals and let them achieve their aims.

13. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

14. Process of Change

15. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

16. Obstacles to Progress 1970 Health Act GMS Contract Private Insurance
Silo Mentality
Universal Health Identifier
Moving Hospital Staff to PC.
Health delivery decided by money
Responsibility separated
Political Will
Lack of Competition-protectionism
Antagonism to SMEs –Public/Private

17. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

18. Potential of Primary Care
Under Utilised resources-staff, sites,
Under Utilised skills- Drs/PN/Others
Low cost (30-50% cost of same in Hospital – international figures)
>90% GP Practices computerised
Complete Medical Record in GP
1500 GP+HSE Sites in all communities
Primary Care Teams (EARLI)
CDM—80% all healthcare
Proven delivery system
4-6% budget shift could solve

19. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

20. Examples of Change Proposed National Diabetes programme
Audited model delivering Midlands, DiGP Cork
Ready to roll out
Retinopathy Screening
Hosp OPD Optometrist, cost €45.
Ultrasound in Primary Care
Cost €100
Saves 3 OPD visits, week delay-cost €1,100

21. Examples of Change
Review of 35 Punch & Excision Biopsies in Primary Care 2011
½ Malignant or Pre-malignant—11  Plastics for wider excision = 22 visits to hospital
Normally 35  Plastics/Dermatology
3 visits- assess, do & review =105
Saving of 83 Hospital visits, around €40,000.

22. Examples of Change Warfarin Clinic MPHC
Old system-12 steps, Blood to hospital—TTR 51%
New Computerised system- 5min appt, near testing & immediate computerised assisted result—TTR 67%
Patient pays—90% satisfaction
CUH saved 5,000 tests pa but keep the resource

23. Role of Primary Care Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001-
Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?

24. Can Supported Primary Care deliver to the Irish Health Service?
YES IT CAN
Keep hospital referrals down.
Allow hospitals to do what they are designed to do.
Immediately bring CDM and it’s benefits.
Provide care near to patient, at lower cost and more effectively.
Change the system from CRISIS management to HEALTH DELIVERY.