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Dr. David Molony MPHC Mallow 13/6/2013
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Dr. David Molony MPHC Mallow13/6/2013
Role of Primary Care
Can Primary Care really make a difference to the Irish health
service?
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care (term from Dawson Report 1920 UK)
Primary Care is the first level of medical intervention—ie Pre-hospital care
Secondary Care is hospital intervention with potential overnight stay
Tertiary Care is Specialist Hospital care
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care
2,600 GPs + 500 other GPs 280 Training Registrars >1,200 Practice Nurses 3-4,000 administration staff HSE pre hospital services- 4,000 PHN, HSE Community Specialists-Physio, OT, S&L,
Psychology, Podiatry etc. HSE Administrative staff Private Community Specialists –mirror HSE
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
General Practice Activity-currently
44% GMS (GP + HSE cover)
56% Private (no HSE cover)
21,000,000+ consultations/yr.-100% pop, >90% satisfaction.24/7, 365, same day presentation, Co-Op contribution, refer 10% hosp (½ for diagnostics), CDM.
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Patient Pathway
GP Gatekeeper role21,000,000+
Primary Care 19,000,000
Full treatment
Secondary Care 1,000,000 diagnostics
Hosp. Stay, OPD,
Tertiary CareSpecialist services
2,000,000
19,000,000
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care Strategy-2001
Provide 90-95% healthcare needs. Patient centred care, near patient, community
emphasis, Flexible hours. Primary Care Teams—7-8,000 patients, co-
operation, deliver care eg EARLI Study in MPHC.
Ease pressure on hospitals and let them achieve their aims.
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Process of Change
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Obstacles to Progress
1970 Health Act GMS Contract Private Insurance Silo Mentality Universal Health Identifier Moving Hospital Staff to PC. Health delivery decided by money Responsibility separated Political Will Lack of Competition-protectionism Antagonism to SMEs –Public/Private
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Potential of Primary Care
Under Utilised resources-staff, sites, Under Utilised skills- Drs/PN/Others Low cost (30-50% cost of same in Hospital – international figures) >90% GP Practices computerised Complete Medical Record in GP 1500 GP+HSE Sites in all communities Primary Care Teams (EARLI) CDM—80% all healthcare Proven delivery system 4-6% budget shift could solve
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Examples of Change
Proposed National Diabetes programmeAudited model delivering Midlands, DiGP CorkReady to roll out
Retinopathy Screening Hosp OPD Optometrist, cost €45.
Ultrasound in Primary CareCost €100Saves 3 OPD visits, 10-12 week delay-cost
€1,100
Examples of Change
Review of 35 Punch & Excision Biopsies in Primary Care 2011
½ Malignant or Pre-malignant—11 Plastics for wider excision = 22 visits to hospital
Normally 35 Plastics/Dermatology 3 visits- assess, do & review =105
Saving of 83 Hospital visits, around €40,000.
Examples of Change
Warfarin Clinic MPHC Old system-12 steps, Blood to hospital—TTR 51% New Computerised system- 5min appt, near testing &
immediate computerised assisted result—TTR 67%
Patient pays—90% satisfaction
CUH saved 5,000 tests pa but keep the resource
Role of Primary Care
Definition of Primary CareComposition of Primary Care
General Practice ActivityPatient Pathway
Primary Care Strategy 2001-
Process of ChangeObstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Can Supported Primary Care deliver to the Irish Health Service?
YES IT CANKeep hospital referrals down.Allow hospitals to do what they are
designed to do. Immediately bring CDM and it’s benefits.Provide care near to patient, at lower cost
and more effectively.Change the system from CRISIS
management to HEALTH DELIVERY.
