GPs and Irish Primary Care System

Question: Discuss about the GPs and Irish Primary Care System. Answer: Introduction A profession is a paid occupation that one chooses and gets trained to attain the qualifications required. Professionals are therefore expected to possess skills and show competence in their profession. All professions are also guided by a code of ethic which all practitioners must observe. This means that professionals are expected to behave in a certain way while attending clients at the workplace. Nursing as a profession has its unique qualifications and ethics that one must attain and observe to be prequalified. According to Gokenbach (2012), the nursing profession is guided by certain unique values that are common to all nurses in the world. Nurses are expected to be responsible, honest, and open to learning, valuing human dignity and desiring to prevent suffering. According to Aiken and Scot (2014), nursing role in the acute care sector determines patient outcomes such as patient mortality, symptom management, and medication management. Nursing is the largest professional group in healthcare, and it is important in providing quality healthcare in Ireland. According to Hovenga E et al. (2010), the society seeks to have modern health care implemented, and in Ireland, nursing professional should ensure that best nursing practices are put in place. The nursing profession engages in two roles that are caring for individuals either as an individual professional or in a group of a coordinated multi-disciplinary team. The emerging eHealth models are consumer based which focus on consumer choice, independence, and empowerment which are in the process of being implemented in the Irish policy and plans (Department of Health and Children eHealth Strategy for Ireland, 2014) Health care policies in Ireland In Ireland, the first documented national strategy for better health services was titled Shaping a Healthier Future in 1994 and the second document was Quality and fairness- a health system for you in 2001. These two documents contained strategies that would improve health services in Ireland which focus on policies for old people as well as policies on womens health. The Irish healthy policy has undergone various changes. In the 1980s the healthy policy in Ireland focused on prevention, health promotion, and self-responsibility. The government was also seeking for strategies that would lead to reduced institutional and hospital-based care. This policy led to a decrease in the number of people getting hospital admissions and also the time that most of the patients spent in the hospitals reduced greatly. This policy resulted in the closure of several hospitals. The Irish health care policy is influenced by international policies. For instance, Health 2020 is a policy that outlines the framework for WHO in the Europe. The main objective of the policy is to ensure sustainable, high-quality health services which ensure equality, the well-being of the people and people-centered services which are available to everyone across all nations (WHO 2012) In Ireland, the government through the health department have enacted many health care policies with the aim of improving the health care sector in the country. There have been two major organizational changes in the health sector of Ireland. The first one occurred in 1970 health services put under the Department of Health which had eight regional health boards, previously the local health authority system was in charge of health services. All regional health board consisted of local authority councilors, senior medical profession representatives, and appointees of the Minister. These boards held meetings each month. The second change took place in 2003 which was influenced by the publication of the Prospectus report. The report aimed at bringing together the health services, to make them efficient and also to rectify the gaps in the previous health service system. The report had proposed four changes in the health service sector which are as follows; The report proposed the abolishment of the health boards and formed a single National Health Service organization that is, the Health Service Executive. The report also suggested that the responsibility of executing policy, administering and managing to be given to the Health Service Executive while the Department of Health and Children (previously Department of Health) would assume the responsibility for deciding on the policies made. The report proposed that the 43 semi-state health agencies should be abolished and bring them into the health department. Finally, the report proposed that the local health systems should be dissolved and give the minister of health the responsibility to govern health services through the Dial. The proposed system abolished the decentralized health service system and brought a national more unified health system in the country. The Heath Service Executive took over the health service sector in 2005 following the approval of Oireachtas of Health Act 2004. However, not all proposal the Prospectus Report have been put in place, but there are remarkable efforts towards the implementation of the report. According to Markham and Carney (2008), Ireland has experienced a number health policies being developed over the years. The developments have been focusing on primary care which aims at providing better health services to the public According to European Observatory on Health Systems and Policies (2009), in the recent times Irelands heath care policy focuses more on primary health sector rather than on secondary or acute sector. The shift to primary health care sector aimed at ensuring that the health services were patient-centered and this would bring about better health care in the future. This shift would also ensure that the patients receive quality health care services at a lower cost. By shifting to primary health sector everyone including the citizens, health workers, and the entire health system since this shift guaranteed better and quality health care since necessary infrastructure would be developed and adequate resources would be provided. According to Roinn Slainte Department of Health (2014), notes that primary care provides a platform where many healthcare needs can be addressed at the right moment and a favorable cost. In Ireland, the primary health care services boast some positive aspects that make it effective such as good professional training and competency standards. However, Irish primary care has not yet developed to satisfy the growing need of the health services in the country. Challenges are facing the implementation of primary health care, but notable, positive progress can be noted. Primary care services is the fundamental component that will ensure that efficient health care services become accessible to all people According to Health Service Executive (2013), the primary sectors are organized into Primary Care Teams (PCTs) which comprises of professionals from different fields of community health from all over the country. Each PCT would be comprised of five nurses that are, advanced nursing practitioners, midwives, clinical nurses, mental health nurses, practice nurse and general nurses. The nurses would also work together with other professionals providing social services such as social workers and psychologist. Clerical and administrative support would also be provided for every PCT. According to a government report, one PCT would serve approximately 3,000 to 7,000 people and therefore for PCTs to be effective it was estimated that approximately 600 to 1000 teams would be required to serve the whole population efficiently. Primary health care was widely accepted by the citizens and also by the nurses. According to Department of Health and Children (2001), the implementation of the primary health sector would require an estimated cost of 2 billion from 2001 to 2011. However, this was halted by the global economic crisis which led to an economic recession in Ireland, and due to this reason, the program has not been fully implemented. Oireachtas (2014) notes that it was expected that by 2011 400-600 PCTs would have been established but only 426 had established at the end of 2012. Therefore the healthcare sector is still in the secondary sector. Department of Taoiseach (2011) states that in 2011, new reforms in the health sector were being proposed which would achieve similar goals to the previous reforms in 2001. They aimed at ensuring that quality health care was easily accessible at a lower cost. In addition to the previous health service reforms, the new reforms also focused on clinical governance in health care delivery (National Directors of Public Health Nursing and Shannon (2014). In 2013 the Government of Ireland established a new policy entitled Healthy Ireland which will guide the health sector from 2013-2025. The policy in a framework that will assist in achieving better health care service which will cater for the health needs of the whole population of Ireland. The policy outlines the vision and the goals that the health sector wants to achieve within that period, and it provides a guided course of action that will be followed in the implementation of the policy. According to Department of Health (2013, pp6-7), the policy recognized the contribution of nurses toward the achievement of the health policies and the important role that health care sector plays in the lives of the people in the community. Ensuring that a huge population is healthy in the country. Ensuring that there is equality in the health care system. Providing protection to the public against health hazards. Creating an environment which allows participation of every individual in ensuring the country is healthy mainly. The attainment of the four goals of the policy relies on the roles played by community nurses. According to WHO (2015), Nurses and midwives are important in the implementation of primary health care since they are cost effective and can greatly reduce cases of hospitalization, and also they can help in increasing positive health outcomes. Roles of nursing in influencing health policy in Ireland According to Sharon (2014) nurses are an integral part of the healthcare system, and their role cannot be assumed. Nurses have a number of roles such as caregiving, communicating and teaching. Though the role of the nurse is at times overlooked and they do not get the appreciation they deserve. As caregivers nurses provide what the patient requires such as attention and prevention of new infections. Nurses also ensure that there is effective care management. While some professionals provide care to patients nurses ensures that all the needs of the patient are met. Nurses also act as advocates and help in protecting the rights of patients. In case the patient is in a critical condition, and he or she cannot act normally nurses have the role to determine what the patient wants. According to Scot et al. (2014), nurses play an important t role in assisting patients in activities that contribute to better health or recovery process. Morris et al. (2013) in his study on the role of nursing in current health services identified that interventions made by nurses in health care contribute to the reduction of physical health problems such as bleeding, infection and physical mobility especially. This shows that nurses help in improving patient outcomes. Without nursing services, the health care service would not be able to provide quality health service to the people. Healthcare in Ireland is in the transition stage where new models of care will be adopted. The new models will allow patients to participate and contribute in the decision making processes that healthcare givers want to make. The new model will empower patients to have the power to control their healthcare planning and maintenance since patients will be able to access their health records electronically. Nurses have the responsibility to ensure that such changes in the healthcare are successfully implemented by informing the patients and educating them (Foster 2014) In Ireland, Emergency Nursing is a distinct area of practice which helps to inform the nursing agenda for the National Emergency Medicine Programme. The Emergency Department (ED) in a hospital is comprised of a multi-disciplinary staff who help in providing the required health services to the patient. Including nurses in Emergency Departments is essential in ensuring that Emergency Medicine Programme (EMP) achieves its goals of ensuring patients in Ireland can access, quality and cost in Emergency Medicine. Nurses play the following roles in EMP; The work together with other medical staffs in providing good care to the patients. Emergency nurses in a multidisciplinary team provide information that helps in the care of emergency patients. Emergency nurses, therapy professionals and medical social workers lease in developing a record that is important in transferring patient care in the emergency department. Competency development According to Undergraduate Curriculum for Emergency Medicine (2009), the advancement in technology and pharmacology and demographic changes has resulted in emergent of different natures of diseases which require a unique model of health care. The society is also becoming aware of the need for safety of the patient's thus higher expectation of improved healthcare services. Thus the need to advance and improve the skills of the healthcare professionals regularly to maintain a highly skilled body of professional in healthcare services in Ireland. Care providers also have the responsibility to ensure that their workers can advance their skills and knowledge by supporting them. This will help in improving healthcare services to the people of Ireland. The Department of Health (2010) notes that the chief nurse established a policy that assists in developing nursing and midwifery roles in the country. The policy aims at advancing and improving the role of nurses and other medical practitione rs. It also advocates for patients centered clinical care that will be delivered appropriately and on time. Competency framework for emergency nursing This framework outlines the skills that will be needed in emergency nursing practice in Ireland. This framework gives guidance on the skills that nurse should acquire before enrolling into emergency nursing to ensure that patients are provided with clinical services. Emergency nursing practice requires a nurse to develop specialized skills, knowledge, and attitudes that will aid in professional development and competence. Competency skill sets were developed from different sources and were further developed through Workforce planning survey and Best Practice Workshops. The main objective of having skills sets is to ensure that professional development needs of emergency nursing are met and also provide better health service care. In the management of every health organization, the Director of Nursing, Chief Executive and Clinical Director have the responsibility of managing nursing resources in the right manner to enhance the provision of quality healthcare services to the patients in the organization. Good governance in the organization aid in the successful implementation of the strategies by EMP in delivering healthcare services to the patients who require Emergency Care Nursing (ECN) care. The following are the various nursing governing roles; Clinical Governance for emergency care roles In the Emergency Care Network, the roles and responsibilities of each staff are defined. Each unit should ensure that its goals and objectives are clear and that every member is given a chance to participate in all activities that the unit performs. Strong relationships between the members of the unit and the nurses should be developed. Effective clinical governance can only be developed if the organization develops good external partnerships and also ensures that its staffs are well trained. Health organizations are also required to strategize on plans that will ensure that better services are offered to patients in the organization. The nursing governance should also be devoted to providing the required ICT infrastructure in every health institution. The main function of a clinical nurse manager is to ensure that nursing activities are delivered appropriately. Clinical Nurse Managers are also responsible for providing clinical leadership, dividing roles effectively, ensure that there is staff development and facilitating effective communication with all stakeholders. Conclusion Ireland is making efforts towards improving health sector by setting up health policies that will ensure health care services are accessible and affordable to every person in the country. In the formulation of health policies, it is important to involve health practitioners and specialists to come up with policies that will be implemented without much strain. There should be short term and long term strategies that will help guide the implementation of health policies that will help in addressing the health needs of the public. The health sector should aim at providing sustainable healthcare services that will directly benefit the patients in the short term. The policies made should also put into consideration future advancements and demands that may affect health care services. To fill the gaps that are being experienced in the implementation of Primary health care in Ireland the government should consider the population and the demand for given health services in every region so as it can distribute resource equitably. The health care policies should be well planned, organized and implemented so that they can meet the need of the people. The population is the most vital factor that should be considered when formulating policy. The implementation framework of the policy should be based on population. This will ensure that the resources distributed will be able to meet the health needs of the whole population without neglecting any section of the population. The department of health in Ireland should ensure that they prioritize integrated care through providing primary services and nursing should be considered in the implementation of health policies. It is important to acknowledge the important that community nursing plays in ensuring that quality health services are delivered to the public, and therefore decisions made should be focused on professional management and advancement. Lastly, the government in unity with the Department of Health should consider th e eligibility of their health policies in meeting the universal health policies to ensure that the country maintains a healthy population. References Aiken L Scott PA (2014), Nurse Staffing and Education and Hospital Mortality in 9 European Countries. A Retrospective Observational Study. EU Programme RN4Cast. The Lancet Brokaw, (2016), the nursing professions potential impact on policy and politics. American Nurse Today Articles. 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