Primary Care Development the current status and future plans. Brian Murphy, National Primary Care Services Manager, Health Service Executive

Transcription

1 Primary Care Development the current status and future plans Brian Murphy, National Primary Care Services Manager, Health Service Executive 9 th May 2009

2 Primary Care Now More than Ever (WHO 2008) Alma Ata Relocate the entry point Measurable benefits Findings hold true in both national and cross-national studies More likely or as likely to identify common life-threatening conditions as specialist care. Adhere to clinical practice guidelines Prescribe fewer invasive interventions, fewer and shorter hospitalisations and have a greater focus on preventive care. Lower overall health-care costs for similar health outcomes and greater patient satisfaction. Generalist professionals working in ambulatory settings are associated with lower overall costs and higher quality rankings.

3 What is Primary Care? Primary care is an approach to care that includes a range of services to keep people well, from the promotion of health and screening for disease to assessment, diagnosis, treatment and rehabilitation as well as personal social services. The services provide first-level contact that is fully accessible by self-referral and have a strong emphasis on working with communities and individuals to improve their health and social well-being. Primary care is the appropriate setting to meet per cent of all health and personal social service needs.

4 Primary Care - Ireland POLICY: Quality and Fairness A Health System for you 2001 Better Health for Everyone Fair Access Responsive and Appropriate Care High Performance. Primary Care A New Direction sets out a plan for the development of primary care in Ireland. integrated, interdisciplinary, high-quality, team-based and user friendly set of services. delivered in the community by integrated multidisciplinary primary care teams and primary care networks. An approach to care that includes a range of services designed to keep people well, from promotion of health, screening of disease to assessment, diagnosis, treatment and rehabilitation as well as personal social services.

5 Current Population Trends Current population 4,422,100 - an increase of over 11% since Additional demands on the HSE: Unexpected increase in the number of births - 70,620 births registered in 2007, some 5% above their projection. Up to 73,700 births in The 0-4 years age group increased by 15% The 85+ age group increased by 27% over period : The death rate for Ireland continues to fall steadily, with a corresponding increase in treatable lifespan. The number of persons unemployed has risen from: 84,600 in 2003 to 195,500 in April 2008 to 385,000 April 2009

6 Transformation Programme Overall objective by 2010 patients will have easy access through primary care teams to high quality care and services Programme 2 Configure Primary, Community and Continuing Care services to deliver optimal and cost effect results

7 The shift from acute: Overview of the Preferred Health System Internal hospital processes are optimised to support high quality care, reduce patient delay and maximise use of the bed stock The nature, capacity and availability of responsive community based services is configured to avoid unnecessary admissions to acute care and to facilitate earlier discharge and a return to independence Patients are involved in their own care of minor, acute and long term conditions with professionals providing a supportive, advisory, educational and skills training role There is an emphasis on illness prevention, early detection and early intervention Acute Acute Care Care Primary, Community and and Continuing Care Continuing Care Self Care No No Care Requirement

8 Programme 2 How will we do it? Develop and implement PCCC configuration framework Reconfigure the existing services that support Primary Care Teams Establish Primary Care Teams Expand and augment services in the community. Implement care group sector specific service transformation consistent with PCCC configuration framework. Implement community scheme modernisation project.

9 What have we to do? Realign - Serve - Establish - Establish - Establish - PCCC Staff 4.2m+ patients/clients 530 Primary Care Teams Closer working relationships with GPs Agreed working protocols, care pathways

10 Erris Primary Care Teams Rathoath Ashbourne Oldtown Swords Donabate Dunboyne Kinsaley Mulhuddart/CorduffFinglasBallymun Blakestown Coolock/Darndale Coolmine Edenmore Killester Roselawn Phibsborough Leixlip Lucan Heights Castleknock MillmountMarino Cabra West Clontarf East Ashtown Lucan Esker East Wall Lucan St Helens Chapelizod/Palmerstown irishtown Celbridge 2 Drumfinn Rialto Pearse st Sandymount Curlew Road Clondalkin Donnybrook WalkinstownRathmines/Terenure Kilnamanagh/Tymon Dundrum Brookfield Limekiln Blackrock Stillorgan Rathcool/Saggart Millbrook Ballyboden Balally Killinardan/Oldbawn Ballinteer Ballyogan/Ballinteer Jobstown Firhouse Ballyogan Kill Shankill Blessington Bray Carndonagh/Clonmany Moville FanadBuncrana Dunfanaghy/FalcarraghRosquill Derrybeg LetterkennyRaphoe/Manor Dungloe Stranorlar/CloghanLifford/Castlefin Ardara/Glenties Killibegs/Rossan Donegal Ballyshannon/Bundoran North Sligo Monaghan Sligo TownNorth Leitrim & West Cavan West Sligo Crossmolina Central Sligo Clones Central Leitrim BallybayCastleblaney Ballina West Cavan South Sligo East Sligo Cootehill Cooley Achill Dundalk Cavan Boyle Carrickmacross Swinford South Leitrim Charlestown Carrick on Shannon Bailieborough/Kingscourt Arvagh/Ballinagh Mid Louth Ballaghadereen WestportCastlebar Ballyjamesduff Ardee Virginia NobberClogher Head/Dunleer Ballyhaunis Strokestown Granard Castlerea Kells Longford Oldcastle Drogheda Slane Claremorris Drogheda/Meath Edgeworthstown Louisburgh Nth Westmeath Navan DuleekLaytown/Bettystown Ballinrobe Glenamaddy Athboy Roscommon Delvin Balbriggan Ballymahon Tuam Mullingar Trim Ashbourne Skerries Oldtown Clifden Kinnegad Dunshaughlin LuskRush Oughterard Mountbellew Innfield Headford Athlone LW Summerhill RathoathSwordsDonabate Abbey Kilbeggan Athlone R Moate Rochfortbridge Dunboyne Kilcock FinglasHowth/Sutton South Connemara Derrinturn Mulhuddart/Corduff Claregalway Clara Celbridge 2 Moycullen irishtown Spiddal Athenry Ballinasloe Ferbane Edenderry Clane Clondalkin Castlegar Daingean Rathcool/SaggartBlackrock City East Kilmeague Oranmore Tullamore Rathangan Kill FirhouseBallyogan Loughrea Banagher Naas Jobstown Shankill Portarlington Newbridge Blessington BrayGreystones Aran Islands Mountmellick Kildare Gort Portumna Monasterevin Kilcullen Newtownmountkennedy Birr Lisdoonvarna Portlaoise Dunlavin Borrisokane Mountrath Athy Wicklow Stradbally Shinrone Baltinglass Rathdrum Scarriff Borris in Ossary Castledermot Roscrea Ennistimon Abbeyleix/Durrow BallickmoylerHacketstown Ennis Nenagh Arklow Carlow Ballina/Killaloe Templemore Castlecomer TullowSouth Wicklow Sixmilebridge Shannon Freshford/Johnstown WestburyNewport Bagnelstown/Leighlinbridge Kilrush Castle Thurles Kilkee Castletroy Kilkenny Bunclody Gorey Ballycummin Rathkeale Cappamore Slieve Ardagh Goran/Graiguenama Glin Patrickswell Callan Cashel BallybunionListowel Hospital Thomastown / Ballyhale Enniscorty Newcastle WestCroom Clonroache Tipperary Kerry Head Kilmallock New Ross AbbeyfealeDromcolliher Ballylanders ClonmelCarrick on Suir Wexford Charleville Cahir Mullinavat Ballyculliane Tralee Taghmon Mitchelstown Bridgetown Newmarket Buttevant Rosslare West Kerry Castleisland Kilmacthomas Waterford Fermoy Tramore Kanturk West Waterford Rathmore Mallow Dungarvan Kilorglin Millstreet Castlelyons Killarney Carrignavar Clashmore Blarney Middleton Youghal Iveragh Kenmare/Sneem Coachford Macroom Riverstown Castlemartyr Carrigtohill BallincolligDouglasCobhCloyne Bishopstown Carrigaline BantryDunmanaway Bandon Ballineen Beara Kinsale 2 Teams Drimoleague Clonakilty RossCarbery 3 Teams Mizen Skibbereen 4 Teams 5 Teams 6 Teams 1 Team

11 Benefits of Primary Care Teams More services available to persons in the community Easier navigation of the system Improved liaison between primary and secondary care services. More resources available to teams Greater networking between communities and providers Reductions in waiting lists for services Information sharing Preventative programmes Patient Care Plans developed Multi-disciplinary Plan Key Worker Patient Involvement Consultant Involvement Weekly Review

12 Progress to Date Entire country mapped into 530 Primary Care Teams. Persons assigned in each LHO to lead out on PCT development Local Implementation Teams/Groups established Total of 110 teams currently holding clinical team meetings Multi-disciplinary team meeting together to discuss patient needs and develop individual care plans. 300 new frontline clinical staff assigned to teams Reconfiguration of 3,500 frontline staff to teams Additional posts required to be filled identified

13 Primary Care Teams in Place Mulhuddart/Corduff Ballymun Darndale Coolock Edenmore Corduff St Millmount Killester Navan Rd/Ashtown Clondalkin Drumfinn Pearse st irishtown Bride St Inchicore A Liberties Ranelagh Brookfield Springfield Jobstown Churchtown Shankill Dalkey Raphoe/Manor Lifford/Castlefin Stranorlar/Cloghan Ballybraick Ballyogan Shankil Bayview North Sligo Erris Crossmolina Achill Achill South Sligo South Leitrim Ballaghadereen Virginia Claremorris Castlerea Longford Athlone Teams 3 of 4 teams gone ahead Roscommon Oughterard South Connemara South Connemara Tuam Athlone Banagher Portarlington Naas Newbridge Mulhuddart/Corduff Ballymun Clondalkin irishtown Brookfield Dundrum Jobstown Ballyogan Naas Teams 3 of 3 teams gone ahead Newbridge Teams 4 of 4 teams gone ahead Lisdoonvarna Borrisokane Birr Athy Newtownmountkennedy Wicklow Tralee Teams 2 of 3 gone ahead Scarriff Roscrea Abbeyleix/Durrow South Wicklow Arklow Bagnelstown/Leighlinbridge Kilkenny Gorey Glin Rathkeale Cappamore Cashel Callan Newcastle West West Kerry Abbeyfeale Tralee Castleisland Newmarket Charleville Slieve Ardagh Mitchelstown Clonmel Waterford Wicklow Teams 2 of 3 have gone ahead Lismore Dungarvan Riverstown Blackpool Ballyprehene/Togher Carrigaline Kinsale Gorey Teams 3 of 3 have gone ahead Mizen RossCarbery Skibbereen Clonmel Teams 3 of 3 gone ahead HSE Staff Meeting Not Implemented Yet Implementation Teams D

14 Current Status of Functioning Teams 110 teams currently in place Other GP PHN Typical Composition of a Primary Care Team SW OT HH Core Extended Phy SLT GPs (3-5) PHNs/RGNs (2-4) Physiotherapist (1) Occupational Therapist (1) Home Help Teams will have 8-15 members and extended members who interact less frequently or as required, but are easily accessible and fully integrated to the PCTs Way of Working. These extended members are typically for specialised services, e.g. speech and language, social work, orthodontics, psychology / counsellors, addiction, dieticians, podiatrists etc.

15 Typical Services of Current Functioning Teams Working together to develop individualised care plans for patients, particularly those with chronic illnesses and other complex needs. Sharing of information and their respective skills Common referral process among team members Provide linkages with the services of other primary care professionals, such as mental health services, specialist child care and disability services. Provide linkages with secondary care - specialist consultants, diagnostic services etc Health promotion and providing services for patients with existing conditions, Some Chronic disease management programmes such as diabetes, respiratory disorders, cardiovascular ailments etc Various programmes depending on established local needs e.g. Falls prevention for high elderly population teams Teen pregnancy programmes Men s Health Cancer Screening Wound Management Stroke Rehab

16 Expansion of Services & Community Initiatives Services will ultimately depend on the local needs of the population and the available resources in the area. Aim to have the following: Chronic Disease Management Services Programmes as determined by community profiles Electronic access to Lab and Radiology tests Direct access to Diagnostics Minor Surgery Out of Hours team services Improved wound care IV Therapy in local CNUs Infusion rooms Cancer Care Health Promotion schools, social gathering, livestock marts, youth club etc.

17 Infrastructural Developments Primary Care Centres Initial advert in December 2007 for 131 locations - Approx 400 applications received New list of locations advertised on 30 th July 2008 for 156 locations - Approx 650 applications received Engagement is ongoing with the interested bidders to progress the sites identified 150 locations approved by HSE Board Aim to have 200 sites identified by the middle of next year, with the first group of 50 to open by the end of 2010 and the full complement to open in the course of centres to open in 2009

18 Centres for 2009 Trim Clongriffen Oranmore Moate Kinnegad Naas Letterkenny Mitchelstown Gorey

19 Integrated Working with Acute Chronic illness Framework Opportunities to shift from episodic acute hospital care to integrated care focused on primary care. Other areas to be progressed: Discharge planning Shared care diabetes, asthma Current hospital care to be provided in the community e.g. cancer initiative, minor surgery Access to Diagnostics Electronic Discharge notes OPD direct access to hospital

20 Integrated Services for Chronic Diseases Established Best Practice Protocols Established Education & Training Buy in & Collaboration Examples: Diabetes COPD Cardiovascular Cancer Resource Shifting e.g. CNS Full Implementation

21 COPD Integrated Care Most people with COPD can be managed in primary care, especially if diagnosed early. Occasionally a small number of patients require expertise and monitoring by respiratory specialist services, in conjunction with their GP and Primary Care Team. The PCT will: Play a central role in managing and co-ordinating care for patients with COPD, many of whom have more than one chronic disease, and attend different care providers. Provide early identification and diagnosis of COPD Provide patient education and self-management, reduction of risk factors, management of acute Exacerbations and long term follow-up. Integrated care pathways will include dynamic individual shared care plans, across settings and disciplines with Primary Care professionals as lead health care workers. As part of the shared care seamless model approach, the skills and expertise of hospital based respiratory professionals should meet/reach/link out to patients and primary care professionals through models of care

22 INTEGRATED DIABETES CARE Primary Care Team Providing bulk of routine medical care. Providing routine review of diabetes parameters. Gatekeeper role. CVD risk assessment. Glucose testing in practice. Some diabetes education. Patient training e.g. in home glucose testing. Day-to-day support. Compilation of a practice diabetes register. Recall and organisation of practice clinic appointments. Each primary care team will have access to a wider network of staff who will provide services for their clients with diabetes - Dietitians, Podiatrists, Pharmacists, CWOs, Psychologists amongst others. Diabetes Nurse Specialists being a resource to the PCT, the patients and a link to the hospital system.

23 Heart Failure Shared Care in Management of Heart Failure Prevention Post Discharge Care First Diagnosis Hospital based Heart Failure Services Hospitalisation GP Regular Clinical Review Direct Access for Clinical Deterioration Annual Specialist Review

24 Next Steps Reconfigure existing front line clinical staff to PCTs. Develop wider network of services and simple systems of working with PCTs Each team linked to specific hospitals Needs Assessment for each Community Community Engagement in Service Planning & delivery Continue to develop appropriate accommodation Further enhance community services and integrated working with Hospitals

25 GP Engagement Meetings with GPs at local level Continued liaison with IMO PCT initiatives demonstration models Primary Care Centres under PPP Initiative New GMS Posts in identified area of need Greater collaboration with ICGP Redefine relationships & strategic alignment roles to deliver on capacity

26 Future Challenges Maximising existing resources shift required to primary care Finance Staffing Increased Patient-centred service Is this better for the patient Build better communication channels and relationships Manage and meet expectations Performance Measurement Demonstrate better health outcomes Acute hospital engagement Seamless services for patients

27 Primary Care in Ireland Now More than Ever or