Dr. David Molony MPHC Mallow
13/6/2013
Role of Primary Care
Can Primary Care really make a
difference to the Irish health
service?
Role of Primary Care
Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care
(term from Dawson Report 1920 UK)
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Primary Care is the first level of medical
intervention—ie Pre-hospital care
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Secondary Care is hospital intervention
with potential overnight stay
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Tertiary Care is Specialist Hospital care
Role of Primary Care
Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care
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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 Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles 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)
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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 Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Patient Pathway
GP Gatekeeper role
21,000,000+
19,000,000
Primary Care
19,000,000
Full treatment
2,000,000
Secondary Care
1,000,000 diagnostics
Hosp. Stay, OPD,
Tertiary Care
Specialist services
Role of Primary Care
Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Primary Care Strategy-2001
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Provide 90-95% healthcare needs.
 Patient centred care, near patient, community
emphasis, Flexible hours.
 Primary Care Teams—7-8,000 patients, cooperation, deliver care eg EARLI Study in
MPHC.
 Ease pressure on hospitals and let them
achieve their aims.
Role of Primary Care
Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Process of Change
Role of Primary Care
Definition of Primary Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Obstacles to Progress
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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 Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Potential of Primary Care
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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 Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Examples of Change
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Proposed National Diabetes programme
Audited model delivering Midlands, DiGP Cork
 Ready to roll out
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Retinopathy Screening
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Hosp OPD Optometrist, cost €45.
Ultrasound in Primary Care
Cost €100
 Saves 3 OPD visits, 10-12 week delay-cost
€1,100
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Examples of Change
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Review of 35 Punch & Excision Biopsies
in Primary Care 2011
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Normally 35  Plastics/Dermatology
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½ Malignant or Pre-malignant—11  Plastics for
wider excision = 22 visits to hospital
3 visits- assess, do & review =105
Saving of 83 Hospital visits, around
€40,000.
Examples of Change
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Warfarin Clinic MPHC
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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 Care
Composition of Primary Care
General Practice Activity
Patient Pathway
Primary Care Strategy 2001Process of Change
Obstacles to Progress
Potentials of Primary Care
Examples of Change
Can Supported Primary Care Deliver?
Can Supported Primary Care deliver
to the Irish Health Service?
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YES IT CAN
Keep 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.
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