frank chambers what gps can and cant do
DESCRIPTION
What GP's can and can't doTRANSCRIPT
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AYRFIELD MEDICAL PARTNERS - OFFICIAL OPENING 2011
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AYRFIELD MEDICAL CENTRE
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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
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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
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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
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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
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OUT OF DATE ITEMSINSTRUCTION IN THE FITTING OF A DIAPHRAGM.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.
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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
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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
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SUSTAINABLE PRIMARY CARE CENTRE
FULLY GP DEVLEOPED AND OWNED
HSE AS ANCHOR TENANT
PRIVATE HEALTH CARE PROVIDERS
SKIN IN THE GAME
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QUALITY IN PRACTICE
• IS AN INTERNATIONAL OCCUPATIONAL HEALTH
AND SAFETY MANAGEMENT SYSTEM
SPECIFICATION
• ALLOWS FUFILL THE QUALITY MEASURE FOR THE
PRACTICE
• PRE HIQA
• EXPENSIVE
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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
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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
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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
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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
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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
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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}
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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
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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
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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,
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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
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WE ARE READY TO ENTER THE DEEP END
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