AYRFIELD MEDICAL PARTNERS - OFFICIAL OPENING 2011

AYRFIELD MEDICAL CENTRE

THE GMS ELEPHANTTHIS IS WHAT WE CANT DO

WE CANT STICK WITH A CRISIS INTERVENTION CONTRACT

OVERRELIANCE ON SECONDARY CARE

NO BASIS FOR HEALTH PREVENTION

1972 CONTRACT

• REPLACED THE DISPENSARY SYSTEM (POOR

RELIEF IRELAND ACT 1851)

• INITALLY FEE PER ITEM

• 1989 CHANGED TO MAINLY CAPITATION BASED

• CONTRACT OF SERVICE RATHER THEN A

CONTRACT FOR SERVICE

PURPOSE OF THE GMS CONTRACT

• PUBLIC PATIENTS HAVE ACCESS TO FREE GP

SERVICES

• HSE ACTS TO PURCHASE SERVICES FROM GPS

• CHOICE AND ACCESS FOR PUBLIC PATIENTS TO

SERVICES

• CHOICE OF GP FOR PUBLIC PATIENTS

• VALUE FOR TAXPAYERS MONEY

ITEMS OF SERVICE DILEMMA

• FEE PER ITEM FOR RANGE OF SPECIFIED

SERVICES

• SUCCESSFUL ITEMS LIKE CRYOTHERAPY, ECG,

FLU VACCINE AND PNEUMONIA VACCINE

• UNECONOMICAL – 25 EUROS FOR MINOR

OPERATIVE PROCEDURE

• 25 EUROS FOR COIL INSERTION

OUT OF DATE ITEMSINSTRUCTION IN THE FITTING OF A DIAPHRAGM.

ADVICE AND FITTING OF A DIAPHRAGM.

DRAINAGE OF A HYDROC0ELE

PLUGGING OF DENTAL HAEMORRHAGE

REMOVAL OF LODGED OR IMPACTED FOREIGN BODIES FROM THE EAR, NOSE

AND THROAT.

WHAT GP’S CAN DO ?

• GPS ARE READY TO GO

• ALL ABOUT RESOURCES- 2 % OF HEALTH BUDGET

– 9 /10%

• THE POOR RELATION OF THE HEALTH SERVICE

• UNTAPPED POTENTIAL WITH HIGH SKILL SET

GENERAL PRACTICE-A BUSINESS WITH EMOTION• MODEL IS FINANCIALLY SUSTAINABLE

• ONLY ARM OF THE SERVICE WITHIN BUDGET

• PRIVATE SECTOR ATTITUDE TO PUBLIC HEALTH

• GPS NEED TO BE AT THE CENTRE OF HEALTH

PLANNING

• COST EFFECTIVE, PATIENT FRIENDLY AND

QUALITY

SUSTAINABLE PRIMARY CARE CENTRE

FULLY GP DEVLEOPED AND OWNED

HSE AS ANCHOR TENANT

PRIVATE HEALTH CARE PROVIDERS

SKIN IN THE GAME

QUALITY IN PRACTICE

• IS AN INTERNATIONAL OCCUPATIONAL HEALTH

AND SAFETY MANAGEMENT SYSTEM

SPECIFICATION

• ALLOWS FUFILL THE QUALITY MEASURE FOR THE

PRACTICE

• PRE HIQA

• EXPENSIVE

ECHO AND EXERCISE STRESS TEST

• CONSULTANT LED SERVICE

• ALL GPS ARE ACLS TRAINED

• PERFORMED BY CARDIAC TECHNICIAN

• TRIAGED AND REPORTED BY CONSULTANT

• SERVICE AGREEMENT HAVE THE ABILITY TO

DEBULK WAITING LISTS

ECHO AND CARDIAC STRESS TESTS

• RETROSPECTIVE CASE OF 223 ESTS FROM JULY

2012 TO APRIL 2013

• 18 WERE POSITIVE, 35 EQUIVOCAL AND 170

WERE NEGATIVE

• HIGH NEGATIVE PREDICTIVE RATE

• COST EFFECTIVE STRATEGY

• REDUCED BURDEN ON HOSPITAL RESOURCES

MENTAL HEALTH CLINIC

• CONSULTATION/LIAISON MENTAL HEALTH CLINIC

WAS SET UP IN APRIL 2010

• A SENIOR REGISTRAR PROVIDED A CLINIC EVERY 2

WEEKS

• STUDY SHOWED LOW DNA RATE AND LOW RATE OF

REFERRAL TO SECONDARY CARE

• PATIENTS WOULD BENEFIT FROM A MORE

EXTENSIVE INTEGRATION BETWEEN PRIMARY AND

SECONDARY CARE

COMMUNITY SURGERY

GMS DOES NOTE RECOGNISE THIS SERVICE IN

PRIMARY CARE

CURRENTLY PAID 25 EUROS BY THE HSE

INSURANCE PROVIDERS PAY APPROX. 133 EUROS

NO FACILITY FEE PAID

COMMUNITY SURGERY

• COST OF A PUBLIC PATIENT IN PUBLIC HOSPITAL IS

1480 EUROS (FACILITY FEE 700 EUROS)

• COST IN PRIMARY CARE CENTRE 510 EUROS (350

EURO FACILITY FEE)

• LOOKED AT 500 OUTPATIENT VISITS TO PUBLIC

HOSPITAL -250 PROCEDURES SAVING OF 970 PER

PATIENT

• GMS DOES NOT RECOGNISE GP’S CAN DELIVER THIS

COMMUNITY SURGERY

• THE PCSA ESTIMATE GP’S CAN WORK FOR AT LEAST

ONE THIRD LESS

• HUNDREDS OF GPS – READY TO GO

• PRIVATE INSURANCE COMPANIES WILL PAY THE

HOSPITALS A FACILITY FEE

• NO FACILITY FEE FOR GP’S --MOLE REMOVAL IN GP

IS {135 EUROS V 800 EUROS PRIVTE HOSPITAL}

IUCD/ COIL COSTS

• UK 2013/2014 NHS TARIFFS: HOSPITAL COST

1285 EUROS

• IRISH HOSPITAL COST ESTIMATED AT 1720

EUROS

• GPS IN UK CURRENTLY PAID (ENHANCED

SERVICE)FITTING, FOLLOW UP AND REMOVAL OF

IUCD £113.71 ( €144}

• IN IRELAND GMS PAYS 66.79 EUROS

JOINT INJECTIONS

• NOT COVERD ON THE GMS

• SAVING PER PATIENT OF 394 EUROS

• 250 PROCEDURES WOULD SAVE APPROXIMATELY

98500 EUROS

• AGAIN FREES UP CAPACITY IN THE HOSPITALS

THE GP TEAM

• MORE FOCUS ON THE DEVELOPMENT OF THE GENERAL

PRACTICE TEAM

• GP AS EMPLOYERS- MORE COST EFFECTIVE

• DEVELOP THE ROLE OF THE PRACTICE NURSE AND

ADVANCED NURSE PRACTITIONER

• FLEXIBILITY OF ROLES – UP SKILLING OF RECEPTIONISTS

– PHLEBOTOMY ETC

• HEALTH CARE ASSISTANT – LUNG FUNCTION TESTS, ECGS

NEBULISERS, BLOOD RESULTS, BP MEASUREMENT,

CHRONIC DISEASE

ICGP SUBMISSION ON COST EFFECTIVENESS AND

EFFICENCY

PROVEN WITH HEART WATCH AND DIABETES

PROGRAMME

QUALITY IN PRACTICE READY TO GO

RESOURCES, RESOURCES , RESOURCES

WE ARE READY TO ENTER THE DEEP END