A major reorganisation of Northern Ireland’s Health and Personal Social Services (HPSS) agency as part of the Review of Pubic Administration (RPA) is currently underway. A Health and Social Services Authority (HSSA) will be set up in place of the existing four Health and Social Service Boards. Seven primary care-led Local Commissioning Groups will also be established as local offices of the HSSA. Five new integrated Health and Social Service Trusts will replace the 18 existing trusts. The Department of Health, Social Services and Public Safety will become smaller. As well as this major change there is considerable uncertainty about the political future and concern that a devolved administration may change priorities and reverse decisions already made. As in many other parts of the UK, healthcare professionals are suffering from change fatigue.
Future plans As has been detailed above there will be seven Local Commissioning Groups set up in the next year. The management boards will have a high level of GP involvement. There are currently no plans for PBC but instead Community Commissioning Associations will be established. These will be partnerships of practices and other healthcare professionals that commission services for a defined population. This will include social care and offers the potential for strong community participation in decision making. The emphasis in these groups will be on partnerships with local communities; one positive legacy of the ‘Troubles’ has been a number of strong local community associations. The individual general practice is seen as the building block of the system. The need for investment in information systems is recognised and investment is planned to ensure a unified and responsive system that will allow the rapid transfer of relevant information. The need for highly qualified and trained staff is seen as a priority, and leadership training is planned for health professionals. A programme for investment in primary care infrastructure is planned with new health and wellbeing centres being constructed to house both individual general practices and the wider primary care teams. There is also the promise of capital investment in GP premises in smaller communities.
Priorities for general practice General practice in Northern Ireland has offered a high level of continuity of individual care. This is threatened by a number of pressures including access targets. With increasing co-morbidity and complex medical conditions being managed in primary care there is a need for longer consultation times. Three issues need early attention: GPs and others involved in commissioning will need support and training to ensure that they achieve the maximum benefits for patients from the new arrangements. The development of robust and imaginative ways is needed to involve patients in setting priorities and in the commissioning process. Improved communication and IT systems are vital if we are to be effective in providing the high level of care expected by our patients. Northern Ireland has an extremely dedicated and caring primary healthcare workforce; they need to be valued and supported. A strong professional ethic within the healthcare community is the patient’s strongest protection. Dr Jennifer McAughey FRCGP Chair, RCGP Northern Ireland
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