Adverse reaction to proposed new primary care system in Northern Ireland
Edited by Barbara Morris
Adverse reaction to proposed new primary care system in Northern Ireland
Changes are due to come into effect in the way in which primary care is delivered in Northern Ireland. According to Ms Bairbre de Brún, the Minister for Health, Social Services and Public Safety, the new Local Health and Social Care Groups, which take effect from 1 April, both will be inclusive and will work for the benefit of the patients in their area. Each group will be made up of five GPs, five Board/Community Trust representatives (three of whom will be a nurse, a social worker or a profession allied to medicine), one nurse, one social worker, one profession allied to medicine, one acute trust representative, one pharmacist, two community/user representatives and a manager. The Minister said that decisions about services would be made at local level, informed by the skills, experiences and knowledge of health professionals who work in front-line services.
During their first year of operation groups will establish their infrastructure, develop their administrative support, undertake a training programme for their management boards and develop projects to address weaknesses in the planning and delivery of primary care services. From April 2003, they will be able to commission a wide range of Health and Social Services and to draw down from Boards the resources necessary. In future years the commissioning role of the groups will grow, as the groups gain experience and confidence.
In an unprecedented alliance, the Royal College of Nursing, British Medical Association (NI) and the Royal College of Midwives have come together to make public their grave concerns and opposition to the new primary care plans for the province. At a press conference in February the three organisations made clear their full support for much needed and long overdue reform of primary care in Northern Ireland. However, they unanimously believe that the new primary care plans will, instead of providing a robust primary care sector, be seriously detrimental to the development of the Northern Ireland health service.
The RCN, BMA (NI) and RCM represent the vast majority of health-care professionals in Northern Ireland. This unique coming-together has stemmed from their belief that, if the proposed new primary care system is implemented as presently structured and funded, they will not be able to deliver services to their patients in the most effective and efficient way. Speaking at the press conference, Carole McIlrath, Primary Care Facilitator, Royal College of Nursing,said: "The RCN is extremely disappointed and has serious concerns regarding the plans announced for primary care.
"Having responded to the consultation document Building the Way forward in Primary Care, it is evident that the proposals we put forward as a result have been completely ignored.
"The RCN fully supports reform in the system for Primary Care and welcomes the potential innovations that could come out of the Local Health and Social Care Groups. We cannot, however, support the fact that what was meant to be a "bottom-up approach" is now going to add yet another layer of bureaucracy to an already top-heavy system. We want to ensure that front-line nurses who work at the heart of the community, and are in an ideal position to be involved in primary care commissioning, are supported and included in these new structures.
"There is a serious lack of purpose, preparation and vision for the new Local Health and Social Care Groups and we need clarification on a number of issues before we can move forward."
Also at the press conference, Dr Brian Patterson, chairman of the BMA's GPs committee in NI, said: "The BMA is totally in support of the development of local multidisciplinary groups with the potential for employing people at grass-roots level to determine the delivery of the service locally. This would help solve some of the problems currently experienced by communities in accessing health care. However, the local health and social care groups, as structured from 1 April, are not going to achieve this.
"One of the problems has been a lack of serious involvement of all stakeholders in the process. Given the totally impractical timescale involved,it has proved impossible for all stakeholders to be involved meaningfully in the process of change. Engagement appears to have been largely at management level."
Echoing the sentiments of the RCN, Dr Patterson continued: "The LHSCGs will not be empowered to influence either commissioning of secondary care services or primary care development. Bearing in mind the composition of the LHSCG management boards, which will be HSS Board/Trust top-heavy, there is little the primary care team will be able to effectively influence, making a nonsense of the 'bottom-up' approach. The quangoism of these bodies is down to the lack of infrastructure and adequate resourcing."
Resourcing of the LHSCGs is one of the main concerns for the RCN, BMA and RCM. The proposal to fund the groups at £3 per patient is believed by the three organisations to be totally inadequate, if a primary care system of prescribing, plus elective care, plus community nursing etc. is to be provided.
The RCN/BMA(NI)/RCM primary care concerns are supported by Dr Maurice Hayes,Chairman of the Acute Hospitals Review Group, the report of which was published in June 2001. He says: "In order not to dissipate the enthusiasm and the expertise acquired through GP fund-holding groups and co-operatives, structures should be set up to involve primary care professionals in commissioning and monitoring services. The bureaucracy should be simplified and flattened,bringing the point of decision nearer to the patient. Boards have outlived their usefulness."
The Minister recognised that a time of change can also be a time of uncertainty: "Experience elsewhere tells us that, once the groups were established and teething problems sorted out, many of these concerns were resolved and the groups have become established as central and important bodies within the NHS."
The Minister also said: "Some professionals have expressed concern as to whether the level of remuneration available for the members of LHSCG Management Boards will be adequate to cover the time commitment they will be expected to make to the development of the new groups.
"No one should be out of pocket as a result of their participation in the groups. If necessary, the Department will undertake a review of the remuneration package, once the groups have been operational for a period."
