HEALTH MATTERS 23 health service


particular, this represents a big challenge as many have been working in isolation. As time goes on we hope to see more and more of the teams around Ireland delivering the ‘joined-up’ local patient–friendly care that all citizens have a right to expect. We are currently sitting on a demographic time bomb, which will see an increase in patients over 65 years, from 11 per cent to 15.4 per cent of the population by 2021. At the same time, pressure on primary care will increase – by 2021 a recent ESRI report has estimated a 50 per cent increase in consultations for already stretched GPs and increasing workloads for other PCT members as the true extent of chronic disease management becomes apparent.


HOW DO WE TRY TO DEAL WITH THESE MAJOR CHALLENGES? Staying as we are is simply not an option as all the evidence points to the current hospital– based model being overwhelmed by the volume and complexity of chronic diseases. International evidence suggests that countries with strong primary care systems in place are the ones that grapple successfully with some of the problems outlined. In Ireland, the cost of accessing primary


care is increasingly becoming an issue as patients without medical cards put off consulting their primary care providers often presenting at a late stage of the disease process.


On the other hand, the cost of providing up-to-date modern equipment and facilities is a real issue for GPs – the days of GPs practicing from car boots is thankfully well over. As a GP, I am seeing more and more young families who don’t have medical cards but who are struggling to afford the costs of medical treatment. This is placing huge strain on already vulnerable people and the resultant mental health issues are becoming a major part of my day-to-day work. We need more GPs. To this end, GP training places are being expanded by 30 per cent from july this year. Secondly, we need to put the resources and facilities in place to allow Primary Care to carry work to its full potential. This involves keeping focus on the development of PCTs and ensuring that IT systems are made available


to primary care to carry out its work in a streamlined fashion. Chronic disease remains the biggest challenge facing our health service with up to three quarters of health expenditure being spent on diabetes, stroke, cardiovascular disease and chronic lung disease. Approximately 80 per cent of GP consultations are related to these diseases and the World Health Organisation has recently estimated that in developed countries, chronic diseases are predicted to increase by 10-15 per cent over the next decade. Clearly we need to tackle this situation urgently.


“as a gp, i am seeing more and more young families who don’t have medical cards but who are struggling to afford the costs of medical treatment. this is placing huge strain on already vulnerable people and the resultant mental health issues are becoming a major part of my day-to-day work”.


Recently, the HSE has established a Quality and Clinical Care directorate under the leadership of dr Barry white. This is a ground-breaking development in that doctors, nurses and allied health professionals are to be involved in real decision-making and resource allocation. One of the first tasks of these groups is to tackle the chronic diseases aforementioned. A clinical programme has been established for each of these diseases with


major input from primary care into the decision making. The top priority of these programmes is to make a real difference in terms of clinical outcomes for these patients. A practical, evidence-based and pragmatic approach is being taken with a focus on what is simple, realistic and achievable. Although proper chronic disease management can seem complicated and unattainable, often simple measures, such as having an asthmatic on proper preventative medication, ensuring that patients at risk of stroke get the appropriate blood-thinning medication to stop clots, or stopping someone with diabetes from getting foot disease can literally make the difference between life and death. These are interventions that can be made by primary care staff such as nurses, GPs,


physiotherapists, dieticians and occupational therapists. If we could save a life a day over the next year from such an approach we would achieve something truly remarkable.


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