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Gold, incentives and meh

Pass Notes : How to set about your Audit Project

By Ian Cameron

The health service in Northern Ireland is to be refocused firmly on primary care, a major strategy report endorsed by ministers has revealed.

The 20-year plan from the Department of Health, Social Services and Public Safety is designed to bring the province's health service into line with the rest of the UK.

Called Caring for People Beyond Tomorrow, it heralds the introduction of GPs with special interests and practice-based commissioning.

It will also bring diagnostic and treatment centres and one-stop-shop care sites to help increase patient choice in the province.

The plan was driven by 'enormous pressure' on the NHS in the province caused by an increasingly elderly population, and the need for an increased emphasis on health promotion and disease prevention.

Shaun Woodward, minister for health in Northern Ireland, said primary care was in need of 'substantial' reform.

'We do much very well but the system can still let people down when they need it most,' he said. 'Too much reliance is placed on the hospital sector. A more responsive and dynamic primary care sector could provide necessary care close to home.'

A tightly-defined timetable sets out how a series of assessments of services will begin immediately with deadlines as early as April 2006.

Dr Brian Dunn, GPC Northern Ireland chair, said he hoped the strategy spelled an end to vague departmental commitments towards primary care, but said he was keen to see more detail about how the changes will be funded to ensure they do not perpetuate historic inequalities.

'There has not been any strategy for primary care at all but we still have a slight suspicion primary care is underfunded,' he said. 'MPIGs and global sums were funded on 2003 levels which were 80 per cent the level of the rest of the UK.'

Dr Jimmy Courtney, Eastern LMC secretary, said GPs would welcome the long overdue strategy, but he had reservations about the value of one-stop-shop primary care centres.

'At long last there seems to be a recognition of the importance of primary care,' he said. 'The department in the past has been all consumed with the hospital sector.'

Dr Keiran Deeny, a GP in Carrickmore, Co. Tyrone, warned the strategy should not be seen as the solution to Northern Ireland's long secondary care waiting lists. He was also concerned that the health service was not further burdened with bureaucracy.

'More treatment in the community is quite correct,' he said. 'Every single day patients and waiting, waiting, waiting and we have to prescribe and treat people more as a result.

'Certainly primary care can help with the problems in

secondary care but it should not be seen as the complete answer and there is a huge personnel and financial investment to be made.'

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