The scale of the challenge Health Minister James Reilly faces in restructuring primary care services is made all too apparent with the publication of the Comptroller and Auditor General’s (C&AG) 2010 report last week.
While the message that progress around developing primary care teams has been slow is not exactly groundbreaking news, the report is yet another indictment of a process that has never really achieved proper momentum. It has been 10 years now since the strategy for establishing a new model of primary care, through the creation of teams and primary care centres, was published. C&AG reports are useful for the detailed focus they bring to topics across the public sector. For instance, the new report states that roughly 100 GPs have not joined primary care teams (PCTs), mainly due to a lack of time, funding and IT communications. Many PCTs are continuing to hold meetings without GP participation, which pretty much defeats the point in establishing the teams in the first place.
GP participation in teams is overstated, the report says, with only 54 per cent of PCTs reporting regular GP practice representation at clinical team meetings at the end of 2010. Survey results conducted by the C&AG show that there are deficits about the number of teams and to what extent they are functioning. Overall, the report says there seems to be a “considerable gaps” between the current configuration of the teams and the ultimate aims of the fully integrated primary care service envisaged in the Health Strategy. Significant work still needs to be done to ensure primary care is managed on a team basis, has embedded systems of team working, and achieves efficiencies and effectiveness through improved shared care arrangements. As ever, the C&AG has come up with concrete recommendations to help the HSE achieve its goals.
Better monitoring needs to be in place to oversee GP participation. The Executive needs to make a definitive decision on the categories of staff that will be assigned to teams based on a detailed analysis of its employment census reports. A new management structure overseeing PCTs is necessary if “fundamental change” is to be achieved. The report does acknowledge the financial restrictions that are plaguing the health services and causing difficulty recruiting staff in occupational therapy, speech therapy, social workers and in administration, but still says that the Executive can be doing more to improve the functionality of the teams. Many changes are on the horizon for GPs and primary care services. Upon the return of the Dáil after the summer break the Minister announced his intention to open up GMS lists. In the longterm, of course, he plans to introduce free primary healthcare, through the provision of universal health insurance. As a GP himself, treating patients at the lowest level of complexity has become his mantra since assuming the role of Minister in March. Despite the new initiatives the Minister has planned, one of his main priorities must be how to put fresh impetus into the development of PCTs.
Next month IMN will carry an indepth report of a day in the life of a primary care team in Dublin, alongside an investigation into the state of services nationally. As the C&AG report shows, more focus needs to be brought to this vital part of our service.
