HSE report highlights value of primary care

Investing in primary care leads to better health outcomes at lower costs, a new report from the HSE confirms.

The author of the report, Prof Tom O’Dowd from Trinity College Dublin, is also concerned at the imbalance in spending between the public and private side of general practice.

Prof O’Dowd, an expert in general practice, said there is international and national consensus on the value of primary care.

The Sláintecare report, a 10-year plan for radical reform of Ireland’s health system, wants people to receive 70% of their healthcare in their community rather than having to travel to the nearest acute hospital.

“Freeing up GPs to spend more time on what they are trained to do requires orientating more nurses, physios, psychologists, and social workers towards primary care,” said Prof O’Dowd.

“There is a lot of scope for investment in Irish primary care to enable it to play a full part in the healthcare system.”

However, while 4.5% of the current budget is spent on primary care, investment in the private side could be better, he said.

Prof O’Dowd said investment in primary care would have to be increased slowly over the next three to five years.

There is a danger that over-investment in the system would put it under pressure, he said, as there are not enough GPs available.

Prof O’Dowd said trainee GPs want to look after patients as best they could but do not want to be sole practitioners.

They don’t see themselves joining the current system, which had got a bad name and is perceived as being underfunded.

With GPs not keen on working on their own, this creates real challenges for the health system, particularly in rural areas.

Prof O’Dowd said a universal health system is financially possible, but a more significant issue is whether GPs want it.

Health Minister Simon Harris said he wants GP representatives involved in contract talks to agree on significant service developments that could be introduced next year.

He expressed concern that Ireland’s primary care sector was not as well developed as other countries. “This research does highlight that we have an awful lot more to do. There needs to be a renewed sense of urgency in this regard,” said Mr Harris.

The report points out that one of the big drivers of healthcare is the increase in the over-65s age group.

The EU average for the 65-plus group is 17%, compared to Ireland’s 13.3%, which was at the lower end of the countries studied. Germany’s over-65s, at 21.2%, was at the higher end.

The report, A Future Together: Building a Better GP and Primary Care Service, was commissioned by the HSE’s primary care division and more than 6,000 people provided feedback.

HSE director general Tony O’Brien said the report was in keeping with the work that the health authority was doing in reconfiguring services away from a hospital-centric system to a primary care-led one.

“It lays the foundations for the changes that we will need to see in primary care and GP care over the next ten years,” said Mr O’Brien.

HSE national director of primary care John Hennessy said the report reinforces the need for decisive change in healthcare and provides pointers for service planning and targeted investment.

“The research is clearly signalling that a strong primary care system is vital to the delivery of high-quality healthcare,” said Mr Hennessy.

The report found that Ireland provides well-trained GPs with good exposure to specially designated training programmes and practices. Last year, the HSE spent €25.5m on GP training. Numbers are being expanded in response to need.

Main findings

* Nine out of 10 patients satisfied with their last GP visit

* Older people who had free access to a GP most satisfied

* Hospital-dominated care unaffordable and inappropriate

* General practice gets 4.5% of the health budget

* Few GPs working solely in private practice

* Most GPS see their future in Ireland

* Trainee GPs do not want to be a single-handed practitioner

* Ireland has around six GPs per 10,000 population

* Access to diagnostics ongoing issue for GPs

* GPs and consultant want a single ‘electronic pathway’

* Overall ease of access to GPs rated highly

* About 2% of patients have received a GP home visit

* GP out-of-hours service provides more than 1m consultations annually and highly rated


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