'The HSE states that, to date, 32 centres are complete and in operation; 16 of these have opened under the leasing arrangement, accommodating 23 PCTs'
Gary Culliton takes a look at some of the diverse activity now taking place in our primary care team network.
The Primary Care Minister Róisín Shortall has met with the HSE on a number of occasions in recent weeks and has asked HSE officials to make significant progress on primary care centre (PCC) rollout over the next 12 months.
The HSE has developed a generic design model for PCCs, with accommodation for up to three primary care teams (PCTs) per centre. It is the Executive’s intention to deliver up to 200 PCCs using this leasing strategy.
The HSE states that, to date, 32 centres are complete and in operation; 16 of these have opened under the leasing arrangement, accommodating 23 PCTs. Primary care centres in disadvantaged urban and small rural towns or isolated areas will continue to be funded from the Exchequer.
At the end of April, there were 368 teams in place, according to Ms Laverne McGuinness, the HSE’s National Director, Integrated Services Directorate Performance and Financial Management. On examining the activity of a number of selected teams during 2010, the following figures show the kind of activity carried out by such teams, McGuinness said.
Almost 70,000 physiotherapy referrals were received and accepted last year. Approximately 69,000 patients were seen for a first-time assessment. More than 230,000 face-to-face treatments/visits were provided in this area and approximately 183,000 “actual clients” were treated.
In occupational therapy, some 23,652 referrals were received and accepted and there were approximately 125,500 direct patient contacts. There were in excess of 339,000 indirect patient contacts and approximately 130,300 actual clients who received a service.
In terms of PCT nursing, approximately 900,000 home visits were undertaken, with more than 1,000,000 individual wound management services provided, including post-operative and compression. Over 62,000 patients were discharged from caseloads.
On average, there are 14 million consultations by GPs each year (including GPs not in PCTs). More than 899,000 contacts were made during 2010 with GP out-of-hour services, with almost 97,000 home visits carried out (this, however, includes GPs not in PCTs).
A number of teams are at the stage where they are developing and implementing specific initiatives to address local health needs. Approximately 240 PCTs (67 per cent) are providing such programmes. Among 356 PCTs last February, 131 had falls prevention programmes; 103 had diabetes care programmes, including diabetes education; 65 had healthy heart or stroke prevention programmes; 56 had antenatal and parenting classes, including breastfeeding support; 35 had health promotion programmes for targeted groups, e.g. women’s and men’s health; 25 had prevention programmes such as weight management; a further 25 had smoking cessation programmes and the same number offered anxiety management; 24 teams had asthma/COPD programmes; 21 provided mental health promotion programmes; while 18 had wound/leg ulcer clinics.
There are currently six Community Intervention Teams (CITs) in place nationally, in Dublin North, Dublin South, Cork, Limerick, Clare and North Tipperary, McGuinness added. The role of this nurse-led service is to provide a rapid response from community services to patients, so that unnecessary referrals to emergency departments or hospital admissions can be avoided and to support early discharge from hospital. The existence of these teams, which are set to increase in number this year, has meant that so far in 2011 some 2,218 people have avoided the need to be admitted to hospital.
'A number of teams are at the stage where they are developing and implementing specific initiatives to address local health needs'
Acute interventions
Examples of acute interventions or enhanced services provided by a CIT include acute anticoagulation care linked to hospital avoidance/early discharge and enhanced nurse monitoring following fractures, falls or surgery, including dressings and acute wound care. Typically, older person support and care short term and linked to hospital avoidance/early discharge are offered.
The development of PCTs and PCCs are a priority under the programme for government. The aim is to provide up to 95 per cent of health and social care in local communities. This will be achieved by increasing activity in the primary care setting and redirecting services away from acute hospitals to the community. The HSE has reported that PCTs were providing services for at least 2.9 million people at the end of March.
The HSE’s definition of an ‘operating team’ is one that is holding clinical team meetings on individual client cases, where GPs and HSE staff are involved. These primary care teams are at different stages of development, with significant variations in the number of clinical team meetings held, the number of patients discussed and the number of patient care plans agreed. It is a key priority for the Government that all teams are fully functional.
Out-of-hours services
GP out-of-hours services cover 90 per cent of the population. In the first four months of 2011, the GP out-of-hours service had 339,625 patient contacts, which is 52,459 more than the same period last year and 21,684 ahead of expected levels of activity. A national review of the out-of-hours service was conducted in 2010 with a view to reducing costs and streamlining the schemes. A number of recommendations were made, including a reduction in the number of call centres nationally from seven to four. Standardisation of drugs prescribed through the out-of-hours service, through the application of a national GP out-of-hours drugs stock list, was recommended. All future payments to GPs should be on the basis of special type consultation claims that would be submitted online via the call management system to the Primary Care Reimbursement Service.
Implementation plans are currently underway in each HSE region. During 2010, almost 12 million home help hours were provided. In addition, homecare packages are provided to more than 10,000 people every month. There were 1,816 new clients in receipt of such packages during the four months of 2011, up 24 per cent on the target.
A total of 21,800 nursing beds are currently supported under the Nursing Home Subvention Scheme (Fair Deal). These measures have contributed to “some improvements” in the number of patients whose discharge from hospital was delayed, according to the Executive.
At the end of April, this improvement over last year stood at 13 per cent (from 673 in April 2010 to 587 in April 2011).