The required skills will be attracted and developed through the establishment of a chair in rural medicine, and providing rural incentives for both GPs and nurses. The focus of management will be on longer term five year strategic planning, supported by an annual funding round based on health service plans for the coming year, where the ability to meet national targets and objectives will be required, but include consultation to develop local priorities. The amount of funding made available will be determined centrally, with explicit assumptions on the level of acute demand. District Health Service boards will be required to fund or provide the range of services necessary to meet the health needs of the community on the medium and long term. There is a specific concern over the current deinstitutionalisation programme.
Funding is provided on an interim basis, leading to uncertainty over sustainability.
This needs to be addressed. Waiting list management will be improved through the definition of maximum waiting times, and the availability of extra money when acute demand increases so access can be maintained. A population funding approach will be used to allocate resources to District Health Services, along with a rural premium recognising that care may cost more when the economies of scale are limited. The priorities are to deliver quality of access, not quantity of expenditure. At a time of change it is recognised there will be a need to fund both the old and new systems.