Primary care is "the central part of the health system and should be of the community for the community". So said the Minister for Health, Mr Martin, during the launch of the Primary Care Strategy yesterday.
It was very clear, from the separate event and from the big turnout of health professionals and others who would not normally be found at a primary care gathering, that this was the real meat in the National Health Strategy sandwich.
The Minister also referred to the consultative process which was set in train earlier this year. "While people may not use the term 'primary care services', they certainly know what they want. They want community-based, well integrated, round-the-clock services that are easy to reach."
There has been some criticism of the availability of general practitioners out of hours, especially in urban areas. Much of what emerged yesterday is not alone aimed at addressing this shortfall, but at providing a service which offers a range of health professionals who will be available in the community on a 24-hour basis.
By the end of 2003, people will be guaranteed an extended out of hours GP service across the State. By the same date, up to 30 of the new primary care teams will be up and running; it is a fair bet that those of us not fortunate enough to be served by one of these will be looking enviously at the level of care offered to our fellow citizens who are.
So what differences will the patients notice? At present, consumers can access healthcare in the community primarily through their general practitioner. Nursing care is available, albeit on a limited self-referral basis. Paramedical services are patchy at best, and in any event must be accessed on referral from a doctor.
There are enormous frustrations for a patient at present. If he needs the help of a public health nurse, his GP will hand him a phone number asking him to contact her. If he is referred to a physiotherapist, he must make his own independent arrangements, albeit with guidance from the family doctor. The inter-professional contact between social workers and doctors is practically zero.
Fast forward to early 2006. The new primary care team is established in your area. You have enrolled with both the team and with one of the four GPs at the purpose-built primary care centre.
You arrive and the receptionist logs you in on the fully computerised system. You elect to see an occupational therapist and the doctor. The OT is currently planning and advising you on the fit-out of a purpose-built kitchen for your wife who has multiple sclerosis and you want to discuss some final details with her.
Later in the afternoon you have an appointment with your GP. It is a routine visit - first of all to see results of your recent cardiac risk screening profile and also to discuss a possible reduction in the anti-depressant medication you are taking. You had started the medication six months earlier when the stress of your wife's illness and the added domestic responsibilities precipitated an episode of depression. You have been doing especially well since you were referred to the psychologist in the local primary care network for cognitive therapy.
The one-stop shop for all primary care needs bears absolutely no relationship to the fragmented and unco-ordinated care currently available in the community. There is no system for offering comprehensive health promotion programmes.
Despite having a National Cardiovascular Strategy, the hard reality is at present that there is no infrastructure in place to implement it.
Soon you will be able to phone a single 1850 number to access all your local health and social services.
There will be a single electronic record of your health and welfare which will ensure the kind of seamless care that health professionals can only dream about at present.
And in the longer term, this strategy offers the opportunity to have laboratory and X-ray facilities in the larger primary care centres.
So instead of travelling to the local hospital for tests, many will be available at the same place as the health professional who ordered them.
By any measure, the primary care document launched yesterday represents one of the most significant proposals ever made for the Republic's health system. It is truly a paradigm shift.