Access by vulnerable people to primary care

WQ.464/2019

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY DEPUTY G.P. SOUTHERN OF ST. HELIER

ANSWER TO BE TABLED ON TUESDAY 22nd OCTOBER 2019

Question

Will the Minister –

1. advise what measures, if any, he has under consideration to meet the objectives contained in the Common Strategic Policy, and reflected in the Government Plan, to improve access for vulnerable people (including children and older people) to all primary care services, including dentistry, and to make it easier and more affordable to use;
2. state to what timescale any such work is being undertaken; and
3. provide his assessment of the impact that any inability to reduce the cost of a G.P. will have on the capacity to deliver earlier diagnoses and treatment in the community and thereby on the potential size and cost of the Future Hospital?

Answer

The Government Plan for 2020 includes a commitment under CSP2 to:

Deliver new models of primary care including:

• expanding our 24-hour community nursing and primary care services

• the development of a model of dental services for children with a preventative focus

• the development of a model to support people with diabetes and their access to primary care

• the development of a model to support access to primary care for financially vulnerable individuals.

1. In preparation for the 2020 actions set out in the Government Plan, working groups have already been established to:

- support the design and delivery of a scheme or service to improve support to primary care services for agreed groups of people with a low income or who are vulnerable

- provide a range of accessible health services aimed at Shelter clients and other homeless people

Plans are also in place to establish a working group to review options for improving access to dental services for children.

2. The Shelter service is now being delivered. Other services will be developed for delivery during 2020.
   100. GP practices are private businesses and are currently able to set their fees as they wish. All GPs offer discounts against their published fees for many patients.

Under the new Jersey Care Model, a new relationship with primary care providers is envisaged in which the government will contract with a wide range of primary care providers, including GPs, to deliver more services in the community, based on the needs of the patient. Those contracts are likely to provide for some services to be provided free to the patient and others may allow for a set patient fee or an unregulated patient fee. The overall aim of the Jersey Care Model is to improve access to patients, and access for financially vulnerable people will be specifically addressed to ensure that cost is not a barrier.

If the plans to develop a new care model do not proceed and no other steps are taken to support primary care costs for financially vulnerable people and the health service remains as now, there will be less early diagnosis and treatment in the community and this is likely to require a larger and more expensive hospital compared to the option where primary care services are expanded.

Subject to the approval of the Government Plan, the actions to move to a more accessible and comprehensive primary care system will be taken.

The need to prevent illnesses developing in the first place, identifying issues as early as possible and providing treatment in the community whenever possible are fundamental cornerstones of the proposed Jersey Care Model. The implementation of the Jersey Care Model will be vital in the successful delivery of a new hospital. These themes are reflected in the 2020 Government Plan under CSP2:

Support Islanders to live healthier, active, longer lives

Support the reduction in preventable disease, through our Reducing Preventable Disease (RPD) portfolio, which aims to reduce the burden of preventable disease and avoidable, early death and reverse the current upward trend in overweight and obesity rates, increase healthy eating, reduce smoking rates and reduce the rates of hazardous and harmful alcohol consumption

Put patients, families and carers at the health of Jersey's health and care system

• Deliver new models of primary care including:

- expanding our 24-hour community nursing and primary care services

- the development of a model of dental services for children with a preventative focus

- the development of a model to support people with diabetes and their access to primary care

- the development of a model to support access to primary care for financially vulnerable individuals.

• Deliver the initial stages of the Jersey Care Model including moving towards services:

- where organisational boundaries between hospital, community and primary care provision no longer affect patients' experience of care or their outcomes

- that are characterised by greater diversity and inclusion for users who are historically less empowered to articulate their health care needs, whether that be because of their mental health, ethnicity, age, gender, disability, cognitive ability or sexual orientation

• Deliver care closer to home, by improving access to services and delivering services in patients' homes, or as close to home as possible.

Good access to preventative and primary care services will be important in achieving these aims. These services will be delivered by a wide range of healthcare professionals, including GPs, and services will be designed to be inclusive to low income groups.