Invest in people, not buildings

THERE’S been widespread debate over the past few months about the location of primary care centres and the criteria used to decide where these centres should be built.

Initially, areas of deprivation were top of the agenda, those parts of the country most in need of healthcare services. Recently, the waters were muddied as to why certain areas were selected and others not. The original criteria seemed to change and there were accusations of political strokes.

It appeared deprivation was no longer paramount when selecting suitable sites. The brouhaha has left many cynical about the whole process. Here in Blackpool, on the northside of Cork city, we are particularly cynical. Despite the HSE clearly stating that Blackpool is a priority area for primary care investment, it was not included in the list that Health Minister James Reilly announced as likely future locations for primary care centres.

There was a proposal to develop a primary care centre in Blackpool. It is a recognised area of need, designated a Rapid area (Revitalising Areas through Planning, Investment, and Development) and a health action zone, meaning it should be strategically targeted for health services as a disadvantaged area.

However, despite these designations and seven years of trying, local GPs have made no progress with either the health or planning authorities in progressing plans for the building of a primary care centre. The whole process has being extremely disappointing and frustrating. It has consisted of meeting after meeting with no firm decision made or deadline set regarding the project, on the part of either the HSE or the City Council.

It appears no one is prepared to make a commitment and decisions have been continually deferred. To add to the frustration, the HSE appears to change the rules regarding the building of primary care centres every few years. It has gone from proposing to build the centres itself, to encouraging others to build while it takes a long-term lease, to public private partnerships where whoever builds will lease for 25 years after which the HSE would own the building.

It is difficult to engage when the rules keep changing, and the HSE appears to have different rules at different levels in its own organisation. After attending numerous meetings and employing architects for plans it was extremely frustrating to see the project abandoned.

The HSE had €2m ring-fenced for the development of a Blackpool centre, but that funding has now gone back into the pot. It is disappointing for the people of Blackpool, who feel they have being neglected again.

The upshot is instead of a new centre, we have another derelict site in an area of the city crying out for investment. As recently as last year, Cork City Council made a commitment to help improve the dereliction in our neighbourhood. Despite this, the area of biggest dereliction is that site once earmarked for our new centre. The only option that remains is for me to build a new surgery, which I am now planning to do, without the involvement of the HSE.

It’s not that centres are essential to the effective delivery of primary care. We have demonstrated ourselves how a primary care team can work without a shiny new building. The Blackpool primary care team is a multi-disciplinary team consisting of GPs, public health nurses, physiotherapists, an occupational therapist, and a dietitian. We also have a drug and alcohol counsellor and two mental health counsellors.

This primary care team meets once a month to discuss patient care and services. By meeting and working together it has served to break down the barriers between different healthcare professionals and has led to a more co-ordinated care plan for patients. The Kinsale primary care team is an example of a excellent primary care team and has won an award despite not working in the same location. It meets in the local community hospital in Kinsale.

Ideally, it makes sense to have as many services as possible under one roof, but we must not wait for new buildings to do this. Developing services for patients must be the focus, especially since it will take decades before all the new centres are built. We should learn from the mistakes of the past and focus on people, not buildings. Investing in people must take precedence over investment in buildings.

* Dr John Sheehan is a GP in Blackpool, Cork city