Republic of Ireland’s Primary Care Strategy: An Analysis

Republic of Ireland’s Primary Care Strategy: An Analysis Primary Care Strategy Introduction â€Å"Primary care is the first point of contact that people have with the health and personal social services.†[1] This means that primary care must be sufficiently well developed to be able to address the most complex and diverse range of health-related challenges and problems that will manifest in healthcare service provision, and make the most of opportunities to promote health and reduce morbidity, across the general population in specific target groups. This essay will explore the Republic of Ireland’s primary care strategy in relation to key goals and targets, and also examine some elements of the strategy in terms of a SWOT analysis. Specific reference will be made to the role of the Specialist Public Health Nurse/Health Visitor Role. Main Body Primary Care can be defined as â€Å"first contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system.†[2] Primary care is about the provision of information, diagnosis, treatment, referral and support for the majority of people who access healthcare services for the first time, and the strategic concerns of primary are related to accessibility, provision of short and long-term care which meets the needs of the population, assessment of those needs, and coordination of services to meet those needs[3]. This has many implications for the provision of healthcare services and the management of increasingly scarce resources. However, it is evident from the literature that in most locations, primary healthcare services still have a long way to go in meeting the goals of primary healthcare itself, particularly in relation to improving integration of services and reorienting services to a person-centred model, rather than a disease-centred model. Primary healthcare is viewed as a means of reducing the use of and demand for overall healthcare services by acting as a gatekeeper for secondary healthcare, and as a means of primary prevention of healthcare problems and disease, particularly in high risk groups of the population, but there is ongoing evidence and debate within the academic literature that there are continuing issues about the lack of egalitarian access to such services and ongoing questions about the ways in which they are provided[4]. It is considered by some that the decisions which govern the design and delivery of primary care services are potentially more based on political drivers than true patient need[5]. Similarly, the gateway function of the primary care service in determining which patients have access to acute care (or secondary care) services may not be based on individual need, but on other factors, such as political, social and even personal factors, including prejudices on the part of healthcare professionals[6]. The primary care strategy, if it provides strong guidance which leads to strong leadership, and perhaps enhances management of care through the use of agreed care pathways which guide decision making, might help eradicate some of these factors. Making the person-centred care model central will also help to remove some of the barriers to egalitarian service provision[7]. However, one of the challenges of the Republic of Ireland model is the fact that two thirds of patients in primary care must pay for their care, which would mean that despite the focus on removing inequalities in access, there continue to be challenges for providing equality of acces s[8]. One of the strengths of the primary care strategy is the focus on improving interprofessional working and communications, as a means of streamlining use of services and preventing doubling up or overlap of services[9]. Improving interprofessional working at the primary care level is one thing, but the strategy also needs to ensure that the intersection between primary and secondary care is properly managed, and that patients moving from acute care settings into community settings continue to have a streamlined, person-centred model of care applied, with good continuity of care[10]. However, there is also a need for the provision of strong leadership, which supports the implementation of the changes associated with this re-orientation of primary care in Ireland, and which supports new ways of working and helps to break down the barriers between the professions[11], [12]. This is where the role of the Health Visitor can be examined in a little more detail, in relation to realising some of the goals of the Primary Care Strategy, and in addressing some of the challenges of this. It has long been the case that Health Visitors work across professional boundaries, and work closely with a range of other health professionals, because within the community, specialist and generic roles are equally required in supporting individual patient need[13]. The interprofessional interface is perhaps one of the most fundamental elements of the work of the Health Visitor, but at the same time is perhaps not given enough attention or credit in terms of the impact that Health Visitors have in the prevention of illness and public health sectors of primary healthcare[14], [15]. The Public Health focus of the primary care strategy is inherent in much of the rhetoric it contains, particularly as it expressly cites the potential for preventive strategies to reduce overall healthcare resource use[16]. It is here that the Health Visitor’s role perhaps has the greatest scope, and should be more strongly underlined, as this is a great resource for change. Research shows that the role of the health visitor is paramount and unparalleled, in reducing risk related behaviours, improving health outcomes, promoting healthy lifestyles and engaging in the more challenging areas of the health/social car interface[17], [18], [19]. However, there is also some evidence to suggest that nurses and, in particular, health visitors, have a key role to play in expanding and delivering the public health dimension of primary care[20]. In particular, the development of improved partnerships in health and social care may be made possible through the role of such nurses, who have the broader community knowledge as well as specialist knowledge of key areas of public health[21]. These partnerships can be developed with a focus on the quality of care provision, not just the identification of need[22], [23], [24]. However, managing the development of improved partnerships, and achieving the goals of the Strategy, is going to be challenging during the transition period, and there may be a degree of uncertainty over roles and boundaries[25]. It might be that Health Visitors are in a prime position to provide the leadership required during such a time. Conclusions and Recommendations. Below is a summary of a brief SWOT analysis of the primary care strategy and isome of its potential implications. Table 1 SWOT analysis of Primary Care (with Reference to the Republic of Ireland Primary Health Strategy[26]) This shows that while there are issues with weaknesses and threats, many of these are the kind that have been present within the primary arena for some time, and it will take good leadership, and good use of existing skills and resources, to achieve the goals of the strategy. While the primary care focus for healthcare services is laudable, there is still the overwhelming need for good resourcing, more clarity about provision, and clear guidance on how to move forward to achieve these goals. Making use of existing roles, such as that of the Health Visitor, whose work crosses the intersections of care at so many points in the primary care sector, could improve quality of care, reduce the impact of the change and transition, and also set standards for the future to increase interprofessional communication and partnership. Certainly it should not be assumed that the strategy will eradicate all the existing problems about the provision of primary care in Ireland, and those problems must still be addressed in future provision[30]. References 213615 Allen, P. (2000) Accountability for clinical governance: developing collective responsibility for quality in primary care. British Medical Journal 321: 608–611. Barlow, J., Davis, H., McIntosh, E. et al (2007) Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation Archives of Disease in Childhood 92 229-233. Campbell, S.M., Roland, M.O., Middleton, E. and Reeves, D. (2005) Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study. BMJ 12;331(7525):1121 Carr, S.M. (2007) Leading change in public health – factors that inhibit and facilitate energizing the process. PrimaryHealth Care Research and Development. 8 207-215. Chavasse, J. (1998) Policy as an influence on public health nuse education in the Republic of Ireland. Journal of Advanced Nursing 28 (1) 172-177. Chavasse, J. (1995) Public Health Nursing in the Republic of Ireland. Nursing Review 14 (1) 4-8. Currie, G. and Suhomlinova, O. (2006) The Impact of Institutional Forces Upon Knowledge Sharing in the UK NHS: The Triumph of Professional Power and the Inconsistency of Policy. Public Administration 84 (1) 1-30. Department of Health and Children (2001) Primary Care: a New Direction. Available from: http://www.dohc.ie/publications/pdf/primcare.pdf?direct=1 Accessed 10-11-08. Douglas, F., van Teijlingen, E., Torrance, N. et al (2006) Promoting physical activity inprimary care settings: health visitors’ and practice nurses’ views and experiences. Journal of Advanced Nursing 55 (2) 159-168. Dunnion, M.E. Kelly, B. (2005) From the emergency department to home Journal of Clinical Nursing 14 776-785. Ewles, L. (2005). Key Topics in Public Health. London. Churchill Livingstone. Jackson, C., Coe, A., Cheater, F.M. and Wroe, S. (2007) Specialist health visitor-led weight management intervention in primary care: exploratory evaluation Journal of Advanced Nursing 58 (1) 23-34. Lordan, G. (2007) What determines a patient’s treatment? Evidence from out of hours primary care co-op data in the Republic of Ireland. Health Care Management and Science 10 283-292. McGregor, P., Nolan, A., Nolan, B. and O’Neill, C. (2007) A comparison of GP visiting in Northern Ireland and the Republic of Ireland. ESRI Working Ppaper Avaialble from www.esri.ie Accessed 10-11-08. McMurray, R. and Chester, F. (2003) Partnerships for health: expanding the public health nursing role within PCTs. Primary Health Care Research and Development4 57-65. Masterson, A. (2002) Cross-boundary working: a macro-political analysis of the impact on professional roles. Journal of Clinical Nursing 11 331-339. Mitchell, P.S., Schaad, D.C, Odegard, P.S. Ballweg, R.A. (2006) Working across the boundaries of health professions disciplines in education, research and service: the University of Washington experience. Academic Medicine 81 (10) 891-896. O’Dowd, A. (2005) Uncertainty over reorganisation is destabilising primary care. BMJ331 1164 Price, B. (2006) Exploring person-centred care. Nursing Standard 20 (50) 49-56. Rummery, K. and Coleman, A. (2001) Primary health and social care services in the UK: progress towards partnership? Social Science Medicine 56 (8) 1773-1782 Stanley, D., Reed, J. Brown, S. (1999) Older people, care management and interprofessional practice. Journal of Interprofessional Care 13 (3) 229-237. Starfield, B. (1994) Is primary care essential The Lancet 344 1129-1133. Thomas, P., Graffy, J., Wallace, P. (2006) How Primary Care Networks Can Help Integrate Academic and Service Initiatives in Primary Care Annals of Family Medicine 4:235-239. Vernon, S., Ross, F. Gould, M.A. (2000) Assessment of older people: politics and practice in primary care. Journal of Advanced Nursing 31 (2) 282-287. Watkins, D., Edwards, J. Gastrell, P. eds. (2003). Community Health Nursing: Frameworks for Practice. 2nd ed. p.35. London, Baillià ¨re Tindall. 1 Footnotes [1] Department of Health and Children (2001) p 7. [2] Starfield, B. (1994) [3] Starfield (ibid) [4] Vernon, S., Ross, F. Gould, M.A. (2000) [5] Vernon (ibid) [6] Starfield (ibid). [7] Price, B. (2006) [8] McGregor, P., Nolan, A., Nolan, B. and O’Neill, C. (2007) [9] Stanley, D., Reed, J. Brown, S. (1999) [10] Dunnion, M.E. Kelly, B. (2005) [11] Carr, S.M. (2007) [12] Currie, G. and Suhomlinova, O. (2006) [13] Watkins, D., Edwards, J. Gastrell, P. eds. (2003). [14] Ewles, L. (2005). [15] Jackson, C., Coe, A., Cheater, F.M. and Wroe, S. (2007) [16] Department of Health and Children (ibid). [17] Barlow, J., Davis, H., McIntosh, E. et al (2007) [18] McMurray, R. and Chester, F. (2003) [19] Douglas, F., van Teijlingen, E., Torrance, N. et al (2006) [20] McMurray (ibid) [21] McMurray (ibid) [22] Allen, P. (2000) [23] Campbell, S.M., Roland, M.O., Middleton, E. and Reeves, D. (2005) [24] Rummery, K. and Coleman, A. (2001) [25] O’Dowd, A. (2005) [26] Department of Health and Children (ibid). [27] Masterson, A. (2002) [28] Mitchell, P.S., Schaad, D.C, Odegard, P.S. Ballweg, R.A. (2006). [29] Thomas, P., Graffy, J., Wallace, P. (2006) [30] Lordan, G. (2007)