Innovation in healthcareIs Primary Care the Answer?

Inaugural National Primary Care Conference 17 November 2011

Prof Walter Cullen

Graduate Entry Medical School

Is Primary Care the Answer?

• What are the challenges facing healthcare in Ireland today?

• What are the policies which aim to address these challenges?

• Can general practice / primary care address these challenges?

…and what about long term sustainability?

The future?

‘More care in the community…’‘GP training places increased…’

‘Integration of care key to efficient health care delivery’‘A new GP contract will provide incentives to GPs to care more intensively for

patients with chronic illnesses’Programme for Government, 2011

The future…

Roland, M, Br J Gen Pract, 2011

Primary care rank versus average health care outcome ranks Starfield, Lancet 1994

Per capita health care expenditures versus primary care scoreStarfield, Health Policy, 2002

General practice in Ireland• An established, independent discipline• Improving patient care through education and service

innovation

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‘Participants were overwhelmingly in support of primary care team working and described numerous advantages for patient care and individual practice.’

Kennedy, Armstrong et al, 2011.

But is it any good?‘Admissions to hospital reduced after intensive intervention to

improve outcomes for patients with coronary heart disease’

‘Clinical guidelines, practice education and nursing support …resulted in improvements in screening’

‘Diabetes can be well managed in general practice using simple tools’

‘Group based peer support intervention is feasible in general practice settings’

Murphy et al, BMJ, 2009; Cullen et al BJGP 2006; O’Connor et al Forum 2011, Smith et al BMJ 2011

‘GPs want information about identifying early psychosis, closer liaison with psychiatric services and rapid intervention service’

Gavin et al et al 2006

‘The service is well-received among GPs. Information delivered through CME appears to have a greater impact on referral rates and satisfaction levels than mailed information.’

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A new challenge for general practice

‘… a diversity of clinical settings including primary, community, step-down facilities and long-term care settings [are essential]’

Department of Health & Children, 2006

‘A fantastic learning experience, made all the better by two GPs passionate about their patients and about teaching’

84% two or more doctors98% practice nurse

100% administrator 46% other healthcare professionals on site

Five on same site as PCTAll indicated an area of special clinical interest (care

of the elderly, child health, women’s health)

Lots of challengesPrimary care and integrated care

part of the answerGeneral practice can respond and

deliverLong term prospects are positive!

Thank you!

Prof Walter Cullen Graduate Entry Medical School

Walter.cullen@ul.ie