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Harris’s big plans for primary care

There is a need to find better solutions to the challenges facing Irish health in the primary care setting and to move away from the obsession with acute hospitals, Minister for Health Simon Harris told the recent Irish Practice Nurses Association (IPNA) 2016 Annual Conference and AGM in Dublin.

The Minister said he was pleased to see that the focus of the conference was on the theme of ‘Healthy Body, Healthy Mind’, as that fit in with his strategy.

There needs to be a shift away from a focus on illness towards health and wellbeing, he said, and that move can achieve better health outcomes.

There are some major problems that need to be addressed urgently at primary care level, such as the national obesity problem, and if Ireland does not “get on top of it” then this is one issue that could be a “ticking time bomb”.

Minister Harris acknowledged that many previous Ministers for Health, going back to the 1980s, would have spoken about giving primary care greater support.

However, he said that if we are serious about it as a nation, then we have to “put our money where our mouth is” and support primary care-givers.

In this context, the Minister said he had listened closely to the call for more support for the further education of practice nurses made by the IPNA Chair Ms Karen Canning.

Minister Harris said there are a number of health areas that he wishes to focus on, and these include disease prevention, early detection, health inequality, the health status of deprived groups, children and those with disabilities or mental illness. All should be encouraged and supported, the Minister said, to live as independently as possible in the community, supported by primary care.

Hospitals

The intense focus by the media and politicians on the acute hospital sector has led to an assumption that solutions to Ireland’s health issues must lie in our hospitals, Minister Harris contended.

However, he said that he wants to see more procedures and care taking place in the community, which is where many solutions might be.

The Minister said that he had visited 20 hospitals this summer, and it was clear that there are patients in Irish acute hospitals who would not be in hospital overseas.

The reason for that, he said, is there is more being done in primary care in other countries and that is negating the need for many patients to go into hospital.

GP contract

It is essential, the Minister told IPNA delegates, that a new, modern GP contract be negotiated to facilitate the required changes in the Irish health service.

There had been no new GP contract for 44 years, a lot has changed in that time and the contract is now an outdated agreement dating back to the 1970s, he acknowledged.

The question is, what do GPs require, in terms of resources, the Minister said, to provide more primary care? The answer should help inform a new GP contract and the negotiations towards that contract will begin shortly, he noted, with the Medical Independent (MI) understanding that some preliminary discussions with GPs have already taken place in recent weeks.

A new GP contract is a crucial building block to move care from the hospital to the GP, and this would mean more management of chronic patients in general practice. The Government is looking at what doctors and nurses, including practice nurses, need in order to be ‘fit for purpose’ to provide more care at primary care level in the community, Minister Harris confirmed.

This would mean changes in how healthcare professionals work, but there is a need to build the capacity of GPs and nurses first in order to achieve what the Minister referred to as “a greater level of interchangeability”.

The Minister addressed the point raised by the IPNA Chair about the disparity regarding education opportunities between practice nurses and nurses in the HSE.

The Minister said that he had heard many healthcare professionals on his tour of Irish hospitals recently say “I can do more” and he wants to facilitate that.

The wish would be to support and develop the expertise and competencies of practice nurses, said the Minister, to prevent illness and support those with long-term health issues.

The establishment of a Chief Nursing Officer was an important development, he said, as it made sure that nurses’ views fed into health strategy.

There is a three-year strategy, Minister Harris added, which will look at nurse numbers in hospitals and see what staff levels in emergency departments are like, while integrating hospital and community nursing and developing more advanced nurse practitioners (ANPs), as he said there are not enough ANPs in Ireland.

So many nurses want to do more and are able to do more, the Minister said, and the HSE needs to roll this out and get more ANPs in hospitals and primary care settings.

Pressure

The introduction of free GP care for under-sixes and the diabetes cycle of care programme has placed a burden on some GPs, the Minister acknowledged.

It is important, he said, before the roll-out of more GP care continues, to put a contract in place, so that GPs can be properly resourced for the new role.

There is also a need to build GP capacity and to increase access to diagnostic and chronic disease management resources at primary care level.

This is an area where Minister Harris sees scope to expand the role of practice nurses and he hopes for a follow-up meeting with the IPNA to discuss this.

The Minister acknowledged that some GPs are being pushed “to the pin of their collar” to keep their practices going, and he wants to lift some of their burden. The concept of salaried GPs is worth considering, he said, because it would remove the need for a GP to be both a business manager and a doctor.

Home care

Another issue the Minister raised was that of society generally wanting people to be allowed to grow old in their own homes.

There is much agreement with this in society, he said, but there is only one statutory scheme in place to help achieve this — the Fair Deal scheme.

This scheme significantly increased the number of home help hours that were available, but these were taken up and demand still outstrips supply.

“We don’t want to have a situation where we say ‘we want you to grow old at home, but all we can guarantee you is a nursing home place’,” he said.

“In the past, we thought success was about how many primary care centres have opened, but the bigger question is, what is happening inside those centres?”

The demands on health services increase as we move into the darker, colder days, and €40 million has been set aside under the 2016 Winter Plan for this purpose, said Minister Harris.

The focus in previous winters has been on providing more beds in the hospitals, but this year, the Government has looked to see what can be achieved in terms of admission avoidance and dealing with delayed discharges, Minister Harris explained.

There were 603 patients still in hospital despite being discharged by a senior clinician on the day of his address to IPNA delegates. The question we want to answer, the Minister said, is how do we get those people back into the community?

In terms of admission avoidance, the Minister said that there has been a targeted expansion of community intervention teams to work with the frail elderly and more funding has been put in place for the winter flu vaccine programme.

The Minister said that he wanted to finish with a clear message to practice nurses.

“I want you to know that as part of the GP contract, we are not talking [just] about a new role for the doctor,” the Minister said,” but to resource practice nurses to do more, look at more ANPs and the anomaly of not being able to access education, like your colleagues in the HSE.”

Minister Harris has previously indicated his desire to have all primary care stakeholders involved in the new GP contract negotiations.

However, will doctors be involved in changes to the scope of nursing practice in the community, in line with the new GP contract?

As reported by MI recently, plans by the HSE to shortly allow nurses to pronounce death in certain circumstances, such as expected death in nursing homes, have had a cool response from the ICGP, with a call for further “discussions with general practitioners on the practical implications of this policy before proceeding further”.

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