Sustaining success in chronic care

One of the recent success stories of the Irish health service has been the introduction of the structured chronic disease management programme in general practice.

Earlier this month, the HSE published the third overview report of the programme.

The report found that the initiative is having a significant positive impact on population health and helping to ease pressure on the acute system.

The programme now reaches over 400,000 patients, with 91 per cent receiving routine chronic disease care within the community.

The report stated that participants had 30 per cent fewer emergency department attendances, 26 per cent fewer hospital admissions, and 33 per cent fewer GP out-of-hours visits.

In the first half of 2024, just 8 per cent of the 270,000 patients who attended scheduled GP reviews had been admitted to hospital in the preceding six months. This compares favourably with Healthy Ireland 2023 data, which reported a 12 per cent annual admission rate among the general population.

The Irish College of GPs welcomed the “highly positive findings”.

The College’s Medical Director Dr Diarmuid Quinlan said the success of the programme stems from a strong sign-up by GPs, with 97 per cent providing the service.

“This GP-led programme has been transformative for eligible patients (those with medical cards or doctor visit cards) living with type 2 diabetes, COPD, asthma and cardiovascular illness – and is a very positive step forward for the provision of care outside of hospitals. The findings also demonstrate the power of general practice to deliver whole country large population health impacts when appropriately resourced.”

Dr Quinlan also highlighted the impact on prevention and early detection. “Since 2020, 51 per cent of new chronic disease diagnoses have been made through GPs in the programme,” he said.

In this issue of the Medical Independent, we feature an interview with the CEO of the College, Mr Fintan Foy, who acknowledged the success of the programme. However, Mr Foy also highlighted the growing pressures facing GPs, particularly due to the increasing medical complexity involved in caring for an ageing population.

“The population has gone up. GPs are seeing sicker people. There is a positive to that. But it is more stressful and more demanding on their time. So from a members’ perspective, I think that’s something we have an obligation to support them on,” he said.

GP burnout is a concern which the College is committed to addressing. But the issue goes beyond the College. At the IMO’s recent AGM in Killarney, the Chair of the GP committee Prof Tadhg Crowley told the HSE CEO that engagement was required on the transfer of work from hospitals to GPs. Prof Crowley added the number of clinical guidelines being submitted to GPs without any corresponding increase in resources was another issue.

The success of the chronic disease management programme should be welcomed. But it must be backed by continued investment – not just to maintain this progress, but to equip GPs to deliver other initiatives as demands on general practice continue to grow.