College Statement on HSE Transformation Programme
The reconfiguration of health services has led to a considerable degree of debate and some disquiet in many circles, including general practice. To date the process has been spearheaded by the HSE and hospital specialists, with little if any meaningful engagement with general practice concerning the implications or practical implementation of the proposed changes.
It is evident to the Irish College of General Practitioners that there is a lack of knowledge and consideration of the work of general practitioners among those deciding on the reconfiguration. We are concerned that the withdrawal or transfer of acute services from some hospital facilities will have a negative impact on patient safety issues for two reasons:
- GPs being expected to provide services outside their areas of expertise and training.
- The increased workload and lack of adequate resources on over-burdened GPs.
The ICGP is the accredited academic body for the specialty of general practice and has adopted the European definition of general practice. The College has also developed a core curriculum of competencies for training in the specialty of general practice reflecting its unique educational content, research and evidence base and clinical activity. GPs are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. GPs care for individuals in the context of their family, their community and their culture and exercise their professional role by promoting health, preventing disease and providing cure, care or palliation. This is done either directly or through the services of others according to the health needs and resources available within the community they serve. It is imperative that GPs are not expected to provide services outside their areas of expertise or training from the patient safety perspective. This form of care is very different to that provided in the acute hospital setting.
Through the HSE's Transformation Programme there is a drive to shift the delivery of services to patients away from the hospital setting and into the community. This Programme has the full support of the ICGP. However, the strategy has cost and workload implications for those providing this care. There has been virtually no transfer of resources from the hospital sector to primary care to match the enhanced demand for various services now provided in a community setting. The need for community based health professionals to be available out of hours is a case in point. To a large extent the extra workload has been absorbed into the existing budgeting arrangements for general practitioners. This is particularly evident in the areas of mental health and chronic disease management. The withdrawal of acute services from some hospital facilities will further exacerbate pressures on GPs to provide their core services.
It goes without saying that appropriate resources, infrastructure and services are verified to be safely operational in the community setting prior to the cessation of any acute hospital-based service.
Dr Mark Walsh
Chairman, ICGP