PART 3

Requirements for implementation

Introduction

The model of primary care described in this document is designed to broaden the focus and extend the availability of services so that the core orientation of service delivery in the health system is fundamentally shifted from an existing emphasis on hospital settings to more appropriate, locally available community-based services that provide a single point of entry for the individual to the full range of health and personal social services. This fundamental change will not be easily achieved. It will require major investment in human resources, physical infrastructure and information and communications technology to develop the new capacity that is required for the primary care services to take on that expanded and enhanced role. Successful implementation of the primary care model will require the commitment and support of the various professional providers and other staff involved in order to ensure that the development and change envisaged is successfully progressed on a partnership basis.

Consultation

The model described sets out the principles for progress; it does not purport to address all of the detailed issues that will need to be worked through in the implementation phases. Consultation with all the relevant stakeholders will be required on the way forward. The Department of Health and Children is committed to working in partnership with the key stakeholders, including service providers, unions, professional bodies, staff representatives and the education sector on the development of a structured programme for the phased implementation of the primary care model over the next ten years. This partnership approach will be achieved through ongoing participation in local and national structures.

Implementation projects

The model described will be implemented on a phased basis to ensure that the necessary capacity building takes place. This will allow the model to be rolled out in a manner that draws on experience gained and enables all relevant professional and user stakeholders to participate in shaping its more detailed aspects. Implementation projects will be initiated around the country on the basis of the principal features of the model set out in this document. It is envisaged that the model will be refined and developed by agreement through the joint learning that these initial implementation projects will allow for. The positive contribution of all stakeholders in a meaningful and open partnership during this implementation phase will be critical to the fundamental reorientation of health service delivery being aimed for.

Suitable locations will be identified for the introduction of implementation projects with a view to having 40 to 60 teams, covering an overall population of approximately 300,000, up and running within 3 to 5 years. The locations will build upon existing infrastructure and local primary care or community development projects as appropriate. The locations of primary care teams for the implementation projects will be selected so that teams can operate in close proximity. This will allow for the development of a wider network of primary care providers that will relate to primary care teams as they develop.

Various models of team working will be applied in the implementation projects. This will include issues such as leadership, team relations, co-ordination and communication. The introduction of primary care teams and networks will not interfere with the professional relationship between individuals and carers. The on-going evaluation of these projects, on a partnership basis, will point the way for the future development of primary care services in Ireland.

Resource requirements

The model described for progression through the implementation projects will require new ways of working for the many professional providers and other staff who deliver the range of primary care services available in the community. The level of integration and enhancement required will need to be supported through investment in physical infrastructure, to provide a co-ordinated, user-friendly, inter-dependent range of services in a suitable location and physical environment. The model is also dependent on an adequate information and communications technology infrastructure and on the ability and willingness of all parties to utilise available technologies. Finally, there are major human resource implications. While cost estimates for full implementation will be informed by the progression of the implementation projects, it is possible to broadly quantify the likely cost implications of the implementation project proposals as they stand and to project outline longer-term costs on that basis.

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(i) Physical infrastructure

Modern, well-equipped, accessible premises will be central to the effective functioning of the primary care team. While for practical purposes teams would be likely to operate out of more than one premises in the short term, the development of locally accessible primary care centres that allow many of the services being delivered to be made available on a single site, providing a single point of access for the user and encouraging closer co-ordination between providers, is a key longer-term implementation objective of the new model. The existing network of community health centres would not be adequate to serve this purpose. The operation of public-private partnerships will be explored as one way of providing the necessary accommodation for primary care teams and the wider networks. At current prices, the capital cost of developing the facility required for the range of services planned is of the order of £2 million (€2.5M) per facility. Taking an initial 40 to 60 implementation projects, and allowing for the fact that the selection of locations will be guided by the availability of good infrastructure where it exists, it can be expected that a capital outlay of approximately £100 million (€127M) will be required during the initial five-year implementation phase. In the longer term, on the assumption that between 400 and 600 core primary care teams will be required for two-thirds implementation in 2011, the capital investment would be in the order of £1,000 million (€1,270M) at current prices. The National Development Plan may provide some of this investment.

These figures indicate the order of investment required and emphasise the need to gain full benefit from existing buildings and to fully exploit any opportunities for public-private partnerships in implementing the development programme. These possibilities will be fully explored in the course of the early implementation phase with a view to reducing the burden on public funding.

(ii) Information and communications technology

Effective communication and pooling of information is essential to the delivery of an integrated service at primary care level. The information and communications technology that is required to support that objective needs to be invested in as a prerequisite to the roll-out of the model. The software, hardware and training requirements to support a secure network with remote access for team members and the wider network of providers will entail significant seed investment and ongoing recurring costs. The costs involved per team are estimated at £60,000 (€76,000) start-up and £15,000 (€19,000) per annum on an ongoing basis, exclusive of training costs. Based on this, together with the ICT costs in developing the wider network, the implementation projects will involve an initial investment of some £5 million (€6.3M) with annualised costs running at an additional £1 million (€1.27M). In the longer term, it is estimated that an investment of up to £50 million (€63M) once-off and recurring costs of £10 million (€12.7M) per annum will be entailed at the end of ten years.

(iii) Human resources

The membership of the primary care teams and the network of primary care providers set out in Part 2 will be drawn from existing professionals and staff to the extent available. The model described, however, represents a major enhancement of the level and nature of services that are currently available in primary care settings. Taking account of the expansion of services involved and of the extended-hours availability of certain core services, including some on a 24-hour basis, the investment involved will be of major significance. Short-term initiatives in terms of equipment, education and personal development will be required.

An estimation of the additional costs involved, allowing for the availability of existing staff and taking account of the makeup of typical core teams and wider provider networks, averages out at approximately £970,000 (€1.23M) per team in the longer term. On this basis, the total cost of the implementation projects would amount to £48 million (€61M).6 Taking into account estimates of existing expenditure, some £25-30 million (€32-38M) additional investment on human resources will be required over the next five years.

Assuming two-thirds implementation (400-600 teams) of the model over the next ten years, approximately an additional 500 GPs and 2,000 nurses/midwives will be required, with similar large increases in health and social care professionals, administrative staff, home helps and health care assistants in order to provide in the range of 400-600 teams as set out in Table 1. The increases in therapy professionals are in keeping with requirements set out in projections made for the Department of Health and Children in the Bacon Report entitled Current and future supply and demand conditions in the labour market for certain professional therapists (see Appendix 1).

Considerations in relation to the supply of human resources in the disciplines required will dictate the pace of investment in the short to medium term. For this reason, in the short term there will be a heavy reliance on existing available human resources in getting the implementation projects up and running, with the expansion of numbers weighing in more heavily on the further roll-out as supply side measures referred to in Chapter 5 of the Health Strategy document are effected in the disciplines involved. At the end of ten years, the staffing costs of implementation will entail an approximate overall investment of £484 million (€615M) per annum.

(iv) Co-operatives

Further development of current GP co-operative models will take place on a national basis as a key support to the enhanced availability for a defined range of primary care services on a 24-hour basis. This will require a framework for the extension of GP co-operatives on a national basis. Along with medical cover, 24-hour cover will be provided through the availability of nursing services, health care assistants and home helps, leading to the development of primary care co-operatives. In this regard, it is expected that a number of teams would come together to provide out-of-hours coverage for population groups. To provide the infrastructure required for the operation of the enhanced 24-hour service an annual cost in the region of £25 million (€32M) is estimated.

(v) Academic centres

A small number of academic centres of primary care will be created, as an authoritative source of policy and practice advice. The precise location, staffing and costing of these centres will be finalised by the National Primary Care Task Force during the implementation phase in partnership with professional organisations, the education sector, the Health Research Board and the Health Information and Quality Authority recommended in Chapter 5 of the main Health Strategy document.

(vi) Community-based diagnostic centres

Three community-based diagnostic centres will be piloted to support primary care and community-based care. Up to £5 million (€6.3M) will be made available for each project. Evaluation of these projects will determine the future direction of such services. Funding will be disbursed via health boards and joint board co-operation and public-private partnerships will be actively encouraged.

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Action plan for implementation

Implementation actions

The implementation of some of the actions required to support the development of primary care, such as improvements in out-of-hours co-operatives and the development of information and communications technology, is independent of the model of primary care. In implementing the model through the initial implementation projects and further roll-out, the following actions will be required.

1. A National Primary Care Task Force will be established

A small, full-time task force, called the National Primary Care Task Force, will be established to take responsibility for driving the implementation of the changes and developments set out in the model. The Task Force will be inter-disciplinary and will report to a wider representative Steering Group which will be chaired by the Department of Health and Children and include representation from health boards, primary care professional groups, unions, and other relevant stakeholders. The Task Force will focus on

• driving the implementation of the primary care model as outlined in this strategy

• identifying representative locations for the implementation projects

• planning human resources, information and communications technology and capital requirements for primary care on a national basis

• putting in place a framework for the extension of GP co-operatives on a national basis with specific reference to payment methods and operational processes.
The Steering Group will give leadership in

• defining a broad set of primary care services which should be provided by primary care teams

• co-ordinating the development of quality initiatives in primary care

• identifying locations for the establishment of academic centres of primary care as a source of policy and practice advice

• developing a national framework for achieving closer integration with the secondary care system

• providing policy advice to the Department of Health and Children, health boards and other bodies as appropriate

• evaluating progress, including an annual report on implementation, on the basis of an agreed set of performance indicators.

2. Individual health boards will prepare needs assessments for primary care teams

Health needs assessment is central to effective primary care and will be a continuous process. The coverage, composition and number of primary care teams in each health board area will be established on the basis of needs assessments consistent with a population health approach, to be initiated by the health boards. These assessments will conform with any guidelines or frameworks developed by the National Primary Care Task Force. They will take into account demographic factors, epidemiological factors, geographical considerations and existing health and social service provision. Needs assessments should specifically identify special needs or areas of disadvantage to ensure that primary care teams can be targeted to meet those needs.

3. A Primary Care Human Resource Plan will be produced

A Primary Care Human Resource Plan will be produced by the National Primary Care Task Force and the health boards to develop the capacity of primary care. Immediate improvements in human resource planning as proposed in Chapter 5 of the main Health Strategy document will be accelerated to enable projected longer-term requirements for staff numbers and skills mix to be identified, particularly in the health and social care professionals. This will allow a greater focus on issues such as health promotion, disease prevention, and rehabilitation as well as diagnosis and treatment. It will also allow for a shift in the location of the delivery of many services from secondary care to primary care, where appropriate.

The Human Resources Plan will require the commitment and support of various professional providers and other staff involved in order to ensure that its successful development and implementation is progressed on a partnership basis. It will be based on the needs assessments to be carried out by the individual health boards.

Developing capacity to provide a broader and more comprehensive range of services in the community means recruiting more general practitioners, nurses/midwives, health and social care professionals, home helps, health care assistants and others, and supporting all staff in ongoing personal professional development.

This capacity will be developed in a number of ways. Initially, priority will be given to short-term solutions such as introducing more professionals whose input can limit the burden on hospital and institutional services and increase the likelihood of people being maintained in their homes. These include in particular nurses, home helps and health care assistants. Short-term mechanisms for attracting more of these professionals into the primary care services will be pursued.

Human resource requirements will need to be reflected in increased intake to relevant undergraduate and postgraduate faculties or in the provision of new undergraduate courses, as appropriate. This will be pursued as a matter of priority with the relevant professional training bodies and the third level education sector.

4. Primary care teams will be put in place to meet the health and social care needs for a specific population

The population to be served by a team will be determined by encouraging GPs to join together their existing lists of enrolled individuals and families, with certain geographic considerations. This geographic focus will strengthen the capacity of the primary care team to adopt a population health approach to service delivery.

In the implementation projects, the other professionals and staff that will make up core teams will be aligned around the resultant general practice lists to provide care to these expanded population groups. Currently general practice populations do not automatically align with community care catchment populations. However, with some flexibility, it should prove possible to agree a basis on which common catchment populations for a combination of both can emerge. Various models of teamwork will be introduced during the implementation projects.

5. Primary care networks will be developed to support the primary care teams

There will be investment in developing infrastructure and human resources in the wider primary care network. This will ensure that there will be continued development in primary care, in addition to the developments taking place in the primary care teams.

6. Availability of primary care services out-of-hours will be extended

In the interests of a patient-centred approach to service delivery, access to primary care services will be improved by extending the hours of availability of primary care professionals and providers and ensuring an appropriate core of services on weekends and public holidays. This will require development of flexible working arrangements and 'twilight' services. New arrangements in this regard will be worked out in full consultation with the professionals and other staff involved.

Resources will be dedicated to further develop GP co-operative cover arrangements on a national basis. In addition to medical cover, 24-hour cover will be provided through the availability of nursing services, health care assistants and home helps. In this regard, it is expected that a number of teams would come together to provide out-of-hours coverage for population groups.

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7. A system of voluntary enrolment will be introduced for primary care users

The entire population will be encouraged to enrol with a team of their choice and with a doctor within that team. The benefits of enrolment will be explained to individuals so that they can make an informed decision on whether to take the opportunity. Enrolment will also serve as an important planning tool for health boards and other public policy-makers in undertaking needs assessments. The system of enrolment will be flexible. Individuals will be free to change teams easily should they so wish. The system will be based on the introduction of a unique person identifier for all health services. This will be developed in the context of the National Health Information Strategy A key purpose of enrolment will be to facilitate a long-term relationship between the client, the team and the wider network of providers. This continuity of care will allow complex health and social problems to be dealt with through a detailed knowledge of clients and their families. The geographic focus of the primary care team will promote social inclusion, by using proactive measures to ensure that vulnerable individuals, families and groups are registered with a primary care team and GP.

8. An improved information and communications infrastructure will be provided for primary care teams

The transformation of the information and communications technology infrastructure to be used will be driven through the National Health Information Strategy and the General Practice Information Technology Project. Key to this will be the development of a single electronic health care record to be used for primary care and other purposes, which will be based upon the system of voluntary enrolment and will include the implementation of a unique client identifier. This is described in Chapter 5 of the main Health Strategy document.
Such an infrastructure has the potential to greatly improve communication, integration and efficiency in primary care and with other elements of the health system. It will include linkages to secondary care electronic records for referrals and results. It will also ensure availability of appropriate hardware, software, education, training and technical support. New services, such as medical card applications and GMS claims on-line, will be prioritised.

9. A system of direct telephone and electronic access to primary care services will be introduced for each health board area

The public will have direct telephone and internet access to information, advice and triage services. These will complement and operate in parallel to primary care services and will be available on a 24-hour basis for those who wish to use them. They will consist of nurse-led telephone advice and triage with appropriate decision support systems and, for those not already enrolled, a link to a team of their choice. In addition to providing
a clear and convenient point of access during core hours, these will act as the point of access to out-of-hours primary care services, as in existing general practice co-operatives. Operational arrangements will be worked through in the implementation projects.

10. There will be greater integration between primary and secondary care

The interface between primary and secondary care will be advanced through a number of initiatives, designed to improve integration. Services will be organised to provide the most appropriate response to initial needs and thereafter may reduce pressure on hospital services. Integration initiatives, aimed at enhancing communication and exchange between primary and secondary care, should be locally agreed but within a national framework to be developed by the National Primary Care Task Force. They will include:

• referral guidelines and protocols for consultant care and diagnostic services

• discharge plans agreed between the hospital and a key primary care worker

• integrated care pathways facilitated by key workers

• individual care plans for certain people, appropriate to their needs

• shared care arrangements for specific health conditions.

11. Community-based diagnostic centres will be piloted

Three community-based diagnostic centres will be piloted to support primary care and community-based care. These will be evaluated on the basis of their ability to provide more accessible services and their cost-effectiveness in terms of reducing the pressure on hospital-based diagnostic facilities. In this regard, the potential of public-private partnerships will be actively encouraged.

12 Policy support for the primary care model will be provided by the Department of Health and Children

Consideration will be given to how best to support primary care and its implementation in the context of the restructuring of the Department of Health and Children, which is recommended in Chapter 5 of the main Health Strategy document.

13. Appropriate administrative arrangements will be put in place to support primary care at local level

The administrative capacity required to support the development of primary care and the implementation of the primary care teams at health board level will be strengthened to ensure that there is a major emphasis at senior level on the planning, development, evaluation and implementation of agreed policy. Responsibility will be identified for management to ensure comprehensive integration is reached. How best to achieve this, and the most appropriate mechanisms for the allocation of funding, will be addressed in the audit of structures outlined in Chapter 5 of the main Health Strategy document.

14. Investments will be made in extension of GP co-operatives and other specific national initiatives to complement the primary care model

In addition to the implementation projects, the full extension of the new model of primary care will require a sustained programme of investment in staffing, buildings and equipment over the next ten years. This increased level of investment will address specific areas needed to complement the new model of primary care including:

• GP co-operatives

• General increases in personnel needed for primary care teams and wider networks leading to improved out-of-hours services

• Information and communications technology.

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15. Modules of joint training and education of primary care professionals will be developed

Modules of inter-disciplinary training between different disciplines at postgraduate level will be developed nationally so as to enhance teamwork, leadership and other competencies. The Department of Health and Children will pursue this in the context of the liaison arrangements recommended in Chapter 5 of the main Health Strategy document. These modules could be incorporated into existing professional training programmes for public health nurses, practice nurses, vocational training programmes for GPs and other professional training programmes.

16. Continuing professional and personal development programmes will be made available to primary care professionals

Human resources within the team and wider network of providers will be developed through a number of mechanisms such as continuous professional and personal development programmes, leadership development programmes and protected time for study, research and courses within core working time. The time and resources to underpin this will need to be provided for in resourcing the teams.

17. A framework for quality assurance in primary care will be developed

A framework for quality throughout the health system is set out in the main Health Strategy document. This will provide for appropriate monitoring and evaluation of effectiveness and outcomes. The National Primary Care Task Force and the Health Information and Quality Authority recommended in Chapter 5 of the main Health Strategy document will have a key role in developing the specific framework for primary care.

18. Academic practice and research will be developed

A key component of a high-quality system is a high-performing research and academic community. As an integral part of the development of primary care there will be a strong emphasis on research and academic practice. A small number of academic centres of primary care will be created, as an authoritative source of policy and practice advice. These academic centres will be inter-disciplinary and will reflect the broad definition of primary care set out in this strategy. The National Primary Care Task Force will identify locations for these centres. The Health Information and Quality Authority will have a key role, drawing on the input of these academic centres, in fostering a culture of excellence, grounded on evidence-based practice throughout the primary care services.

19. Mechanisms for active community involvement in primary care teams will be established

Community participation in primary care will be strengthened by encouraging and facilitating the involvement of local community and voluntary groups in the planning and delivery of primary care services. Consumer panels will be convened at regular intervals in each health board. At local level, primary care teams will be encouraged to ensure user participation in service planning and delivery. Consumers will also have an input to needs assessments initiated by individual health boards. A greater input from the community and voluntary sector will enhance the advocacy role of primary care teams in ensuring that local and national social and environmental health issues, which influence health, are identified and addressed.

20. Strategy for Nursing and Midwifery in the Community will be developed

The Strategy for Nursing and Midwifery in the Community, which is being developed at present, will be guided by this primary care model and will address the deficits in the current system by providing a plan for the integration of nursing and midwifery services within primary care. This strategy will build on the existing diversity of nursing and midwifery competencies, currently provided by public health nurses, practice nurses, general nurses, midwives, community mental health nurses and others. The strategy will seek to maximise the use of nursing/midwifery competencies in the provision of a needs-led, high-quality and sustainable primary care service.

It will also consider the potential for the role of the clinical nurse specialist/clinical midwife specialist and advanced nurse practitioners/advanced midwife practitioners as members of the primary care team, in line with the guidelines developed by the National Council for the Professional Development of Nursing and Midwifery.

 

Timeframe and targets

In the first year there will be an emphasis on developing the structures to support the introduction of this model of primary care at a national level. Work will then commence on the development of the implementation projects in each health board area, building on existing infrastructure as far as possible.

Each health board will initiate needs assessment for primary care teams. Workforce requirements will also be prioritised, including the commencement of a human resource plan for primary care. One immediate priority will be the introduction of services which will have the greatest likelihood of reducing pressure on the hospital system, e.g. home helps and health care assistants.

By the end of the second year, early implementation projects will be up and running. Local administrative structures will be in place in each health board area to support the development of the new primary care model and agreement on a framework for evaluating the implementation projects will be in place. Outcomes from the consultation on progression of the model will inform refinements in the implementation process. Out-of-hours services and co-operatives will also be expanded on a national basis.

By the end of the fourth year, 40 to 60 implementation projects will have been established nationally, serving an aggregate population of 300,000 people. The system of patient enrolment will be in place in each health board area and will be promoted locally. There will also be measures in place to achieve improved alignment of primary care service providers in areas where implementation projects have not yet been established. Community participation in issues relating to primary care and feedback regarding developments to the service will be encouraged on an on-going basis.

In ten years time, between 400 and 600 core primary care teams with wider providers networks will be in place. This is approximately two-thirds of the full implementation of the model. The population health focus will promote a much closer collaboration between the public and the primary care team, resulting in a growth in innovative and community-led initiatives. Those enrolled with a particular team will be encouraged to attend for screening and health promotion advice. Issues such as joint training will also have been addressed by this stage and initiatives undertaken in the context of the wider quality agenda set out in the main Health Strategy document will have facilitated the widespread development, dissemination and adherence to treatment and care protocols and the use of evidence-based models of best practice throughout primary care services. An action plan including target dates for implementation of the primary care model is set out at Table 3. The timetable is indicative and is contingent on availability of resources, partnership with the service providers and stakeholders and the learning derived from the implementation projects.

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Table 3: Action Plan

Action Deliverable Target date Responsibility

1. A National Primary Care Task Force will be established

Task Force established

Jan 2002

Department of Health and Children

2. Individual health boards will prepare needs assessments for primary care teams

10 needs assessments completed

End 2002 Health boards

3. A Primary Care Human Resource Plan will be produced

Human Resource Plan for Primary Care

End 2003

Primary Care Task Force,* Health Service Employers Agency and health boards

Increase intake to third level training places for primary care providers

2003 Primary Care Task Force,* Health Service Employers Agency, Inter-Departmental Committee and education sector
Consultation with stakeholders On-going Primary Care Task Force* and health boards

4. Primary care teams will be put in place to meet the health and social care needs for a specific population

20-30 primary care teams for implementation projects

End 2003

Primary Care Task Force* and health boards

40-60 primary care teams for implementation projects End 2005 Primary Care Task Force* and health boards
400-600 primary care teams in place End 2011 Primary Care Task Force* and health boards

5. Primary care networks will be developed to support the primary care teams

Network arrangements for 20-30 implementation projects in place

End 2003

Primary Care Task Force* and health boards

Network arrangements for 40-60 implementation projects in place End 2005 Primary Care Task Force* and health boards
Network arrangements for 400-600 teams in place End 2011 Primary Care Task Force* and health boards

6. Availability of primary care services out-of-hours will be extended

Extended hours and GP co-operatives available nationally

End 2003

Primary Care Task Force and health boards*

Primary care co-operatives in place for implementation projects End 2004 Primary Care Task Force and health boards*

7. A system of voluntary enrolment will be introduced for primary care users

System in place in each health boardDeliverable End 2005 Primary Care Task Force,* Department of Health and Children/Inter-Departmental Committee and Health Information and Quality Authority

8. An improved information and communications infrastructure will be provided for primary care teams

Electronic patient records and supporting ICT infrastructure in place for 40-60 implementation projects

End 2004

Primary Care Task Force; health boards* and Health Information and Quality Authority

Electronic patient records and supporting ICT infrastructure in place nationally End 2008 Primary Care Task Force; health boards* and Health Information and Quality Authority

9. A system of direct telephone and electronic access to primary care services will be introduced for each health board area

1850 number, support software, website and trained personnel in place in each health board End 2003 Primary Care Task Force and health boards*

10. There will be greater integration between primary and secondary care

Frameworks for referral, care pathways, shared care, access to diagnostic services, and discharge arrangements between primary and secondary care in place

End 2003

Primary Care Task Force,* health boards and Health Information and Quality Authority

Local arrangements for referral, care pathways, shared care, access to diagnostic services, and discharge between primary and secondary care in place End 2004 Primary Care Task Force and health boards*

11. Community-based diagnostic centres will be piloted

Three community-based diagnostic centre pilot projects in place

End 2005

Department of Health and Children, Primary Care Task Force and health boards*

Diagnostic centre pilot projects evaluated End 2007 Health Information and Quality Authority, Primary Care Task Force and health boards*

12. Policy support for the primary care model will be provided by the Department of Health and Children

Responsibility for primary care identified in the restructuring of the Department On-going Department of Health and Children

13. Appropriate administrative arrangements will be put in place to support primary care at local level

Agreement on local management structures to support the model following audit of functions and structures in the health system
End 2003 Department of Health and Children, Primary Care Task Force and health boards*

14. Investments will be made in extension of GP co-operatives and other specific national initiatives to complement the primary care model

 

GP co-operatives available nationally

End 2003

Primary Care Task Force and health boards*

Increases in personnel needed in both teams and networks on a national basis On-going Primary Care Task Force,* Health Service Employers Agency and health boards
New physical infrastructure and equipment On-going Primary Care Task Force,* health boards
Availability of information and communications technology nationally On-going Primary Care Task Force,* health boards and Health Information and Quality Authority

15. Modules of joint training and education of primary care professionals will be developed

Inter-disciplinary training modules (postgraduate) in place End 2005 Primary Care Task Force,* Inter-Departmental Committee and education Sector

16. Continuing professional and personal development programmes will be made available to primary care professionals

Programmes in place in each health board End 2003

Primary Care Task Force, health boards* and Office for Health Management

17. A framework for quality assurance in primary care will be developed

Framework developed and agreed End 2004 Primary Care Task Force, health boards and Irish Centre for Health Excellence*

18. Academic practice and research will be developed

Five academic centres in place End 2006 Primary Care Task Force, education sector,* Health Research Board, Inter-Departmental Committee and Health Information and Quality Authority

19. Mechanisms for active community involvement in primary care teams will be established

Consultation with consumer panels in each health board about specific primary care development On-going Health boards

20. Strategy for Nursing and Midwifery in the Community will be developed

Publication of Strategy for Nursing and Midwifery in the Community End 2002 Department of Health and Children

*Identifies lead responsibility

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