1. Primary Care Priorities forFuturePRIMARY CARE CONFERENCEBrian MurphyHead of Planning, Performance & ProgrammeManagementPrimary Care19th November 2014

2. Overall Objective A more balanced, Integrated Health Service More healthcare in Primary and Communitysettings Strong on Safety & Quality Strong on Access Improved Customer service Good value for money 3. Overview of Integrated HealthSystemAcute CareAcute CareAcute CarePrimary CarePrimary, CommunityandContinuing CarePrimary, CommunityContinuing CareSelf Self CareSelf CareNo No Care Care RequirementNo Care RequirementInternal hospital processes are optimised tosupport high quality care, reduce patient delayand maximise use of the bed stockThe nature, capacity and availability of responsivecommunity based services is configured to avoidunnecessary admissions to acute care and tofacilitate earlier discharge and a return toindependencePatients are involved in their own care of minor,acute and long term conditions with professionals providing a supportive,advisory, educational and skills training roleThere is an emphasis on illness prevention, earlydetection and early intervention 4. Policy Influencers 5. Some Policy Documents & Papers Primary Care A New Direction Community Healthcare Organisations Healthy Ireland Future Health - A Strategic Framework for Reform of the HealthService 2012 2015 The Path to Universal Health Care E-Health Strategy for Ireland The Establishment of Hospital Groups as a transition toIndependent Hospital Trusts Primary Health Care - Now More Than Ever World HealthOrganisation National Standards for Safer Better Healthcare Corporate Plan/ Service Plan/ Operational Plan 6. Primary Care DivisionIncludes: Primary Care Services Primary Care Reimbursement Service (PCRS) GP Out of Hours Social Inclusion Services Oral Health Medicines Management Civil Registration 7. Finance and HR 2015FinancePrimary Care Division 3.36bContracted providers GPs, Pharmacies, Optometrists etc.WTE (September 2014)7,0009,323 8. Primary Care - Key Priorities for 2015Primary Care Improve access to primary care services and reduce waiting lists and waiting times Implement models of care for chronic illness management Implement service integration measures to reduce the reliance on acute hospitals andreduce the number of delayed discharges Extend the coverage of community intervention teams and improve access to primarydiagnostics Enhance oral health and orthodontics services Roll out the community oncology programmePCRS Extend access to GP care without fees to children under 6 years and adults over 70years Introduce service improvements in relation to medical card eligibility assessment andmanage medical card provision and reimbursement Develop further medicine management programmeSocial Inclusion Improve health outcomes for persons with addiction Contribute to reductions in levels of homelessness Enhance the provision of primary care services to vulnerable and disadvantagedgroups 9. COMMUNITY INTERVENTIONTEAMSWHAT ARE THEY? Nurse led service providing care for thepatient in their home/community Service supports early discharge,admission avoidance & reduces costs Standard of care provided must be ofequal, if not higher, quality than usualstandard (often inpatient) care.8 CITs in IrelandDublin SouthDublin NorthCarlow/KilkennyLimerickTipperaryClareCorkGalway 10. Services Provided by CITs thatsupport Early Discharge Intravenous Treatment OPAT short & long courses Blood & Fluid Management Patient care such as acute anticoagulation & urinary related care End of Life Care Other medical conditions such as COPD & Diabetes 11. CIT Total Referrals & Bed DaysSaved 12. Sample Activity Targets 2015 - SummaryPrimary Care 960,000 Out of Hours GP contacts 26,000 referrals to Community Intervention Teams 754,000 Physiotherapy patient contacts 230,000 Occupational Therapy patient contacts 22,000 Orthodontic patients in treatmentPCRS 1.7m medical card holders 412,000+ GPV card holders 2.4m DPS claims 18.6 million prescriptions 1.4m Dental Treatments (DTSS complex & routine) 848,000 Community Ophthalmic Treatments (adults & children)Social Inclusion 9,400 Opioid substitute treatments 1,200 Needle Exchange Packs 1,440 Hep C Assessment of Needs offered (State infected) 13. Specific Developments 2015Primary Care GP access - children aged 0 - 6 years and over 70s Implementation of Community Healthcare Organisations Reduce waiting times for assessment and treatment (therapyservices, orthodontics) Expand Community Intervention Team activity & OPAT services Support discharge of Complex patients/ Special Care Babies Review Community Demand-led Schemes Chronic Disease Prevention and Management Improve Ultrasound access Commence implementation of Electronic Patient ManagementSystem & Individual Health Identifier Dental and Oral Health Initiatives Secure Email Roll out Preparation for National Standards for Safer Better Healthcare 14. COMMUNITY HEALTHCAREORGANISATIONS 9 Community Healthcare Organisations(CHOs) 90 Primary Care Networks 100 GPs involved in Business and ClinicalManagement 15. Specific Developments 2015(contd)Social Inclusion National Drugs Strategy implement actions on early intervention, treatmentand rehabilitation Opioid Treatment Protocol implement recommendations Tier 4 Report implement recommendations Pharmacy Needle Exchange Implement Clinical Governance Framework for Addiction ServicesPCRS Implement first phase of universal GP Service 0-6 year olds and Over 70s. Improve the operation of the GMS Scheme on foot of the Report of theMedical Card Process Review and the Report of the Expert Panel on MedicalNeed and Medical Card Eligibility Provide newly licensed Hep C drugs Medicines Management Achieve Reference pricing and generic substitutiontargets Data sharing Revenue Commissioners and Dept of Social Protection 16. CAPITAL DEVELOPMENTS Primary Care Centres Exchequer funding PPP Operational Lease model Expressions of interest now being sought toadvance further primary care infrastructure 17. Enablers Management and Clinical Governance Structures Fit for purpose Contracts GP Training and GP Manpower Clinical Programmes Electronic Patient Management System/ Individual HealthIdentifier Service Integration / Discharge Planning / CIT Health Needs Assessments and Service User Involvement Managing Culture and Relationship Building 18. Key Messages Safety and Quality Prepare for HIQA Standards Develop safety and risk structures Develop quality indicators Implement investigation report recommendations Conduct audits of performance Access and Patient Centred Reduce waiting times Improve access Improve integration Efficiency and Productivity Re-engineer work processes and practices Introduce Model change Productivity ratios Technology Patient Management System Electronic GP referrals Health identifier initiative Secure email 19. THANK YOU