Dr Tony O'Sullivan

By Gary Culliton.

A man under the care of the Irishtown Primary Care Team (PCT) who was featured on RTÉ’s Operation Transformation programme lost an impressive four stone in weight.

“He got the benefit of the dietician on the team as well as the psychologist and the occupational therapist (OT) discussed occupational issues with him. He turned his life around following that input,” said Irishtown GP Dr Tony O’Sullivan, who will discuss obesity and its impact on society at the upcoming ’Learning Together to Work Together’ — a conference being held at the Crowne Plaza Hotel, Santry, Dublin, on May 25.

The patient involved was a former rugby player now working as a gardener.

“He changed every aspect of his life and did very well,” Dr O’Sullivan told Irish Medical Times. “Our focus is not on short-term weight loss — reaching a target within a certain length of time. Our approach involves getting people to look at their own lifestyles and changing them permanently. We would like smaller changes that are permanent, rather than big changes that only last a little while. If we can motivate people to change their lifestyle, lose some weight and do more exercise, a lot of their sugar problems disappear. That is as important in management as taking tablets.”

Irishtown PCC has a team, the East Coast Area Diabetes Scheme, dealing with patients with diabetes. A dietician and a nurse come to the centre and diabetes clinics are held once a month. Patients get two visits a year at the practice and one annual review at the hospital.

“Unless you chase people up and make sure you see them at least twice a year, it will not be effective care,” suggested Dr O’Sullivan, who is involved in the ICGP diabetes course. “We have a register at the front desk. We invite people for appointments. If they do not come, we chase them vigorously. It requires a specific set of resources and a transformation of the practice to make that possible.”

Also speaking at the conference will be Consultant Endocrinologist Prof Donal O’Shea on ‘Obesity Management in Primary Care’; Dr Brenda Corcoran, Consultant in Public Health Medicine, on ‘Immunisation’; Prof Kathy Murphy and Dr Dympna Casey of NUI Galway on ‘The ‘Prince Study’’; Dr Tony Foley, GP, Deirdre Cullen, OT, and Kate Lynch, SLT from Kinsale PCT, on ‘The Learning Journey’; Dr Brid Hollywood, GP Clinical lead in Mental Health and Pearse Finnegan, Mental Health Programme Manager, ICGP, on ‘Can general practice and primary care deliver a comprehensive mental health service to the patient?’; and Dr Turlough Bolger, Consultant in Paediatric Emergency Medicine, on ‘Paediatric Emergency Care models for the future’, among others.

gary.culliton@imt.ie

Dr James Reilly

By Lloyd Mudiwa.

The Minister for Health Dr James Reilly has allowed the Review Group on the National Paediatric Hospital a two-week extension of the deadline for the submission of its report.

The move follows a request from the Chairman of the Group, Dr Frank Dolphin, seeking additional time.

“As the work of the Review Group is not yet complete it is considered appropriate to wait ‘til the end of the process to provide the list of entities and groups that will have made submissions,” Dr Reilly responded.

The Group, which was established by the Government to review the decision of An Bord Pleanála to refuse planning permission for the multi-million euro hospital on the Mater Hospital site, had been required to report within 56 days of its first meeting, which was due next week.

In his letter requesting the extension, released by the Department of Health, Dr Dolphin said: “In pursuing its work, as laid out in the Terms of Reference of the Group, the Group has met with a wide range of groups and individuals. These have so far included those hospitals which have made submissions based on proposed tri-location; representatives of the existing Dublin children’s hospitals and the Dublin maternity hospitals; clinical and research /academic stakeholders; parents, young people and other representative groups; and representatives of other interested groups.

“The Group has not yet completed its schedule of meetings with stakeholders and interested parties, however.”

lloyd.mudiwa@imt.ie

By Pat Kelly.

Statistics from a new survey show that if a friend or loved one were suffering with depression, almost half would not even want to know about the problem.

There is still a major issue around the difficulty people have in even discussing the topic of depression openly, results from the Lean On Me Pharmacy campaign have shown, as well as the fact that 65 per cent of people were not aware that they could discuss their condition with pharmacists.

GPs were still seen as the ideal first point of contact for depression treatment, with 77 per cent of those surveyed indicating that they would have their illness treated in primary care. Some 74 per cent of respondents said that they would contact a GP if a family member was suffering from depression. However, 49 per cent of people said that pharmacists could provide worthwhile information on mental health conditions.

The research was conducted face-to-face with respondents in 63 different locations and focused on people over the age of 16 years old.

pat.kelly@imt.ie

By Lloyd Mudiwa.

It is likely that the Working Group on Medical Negligence Litigation, which is due to issue its second report soon, will recommend the adoption of a pre-action protocol in respect of clinical negligence cases which will help contain legal costs, the State Claims Agency (SCA) has said.

Ciarán Breen, Director of the SCA, which manages the Clinical Indemnity Scheme, said the purpose of such a protocol would be to significantly reduce the number of medical negligence claims that ultimately proceed to litigation. “If the protocol is introduced in the future, legal costs in respect of these cases should be contained at more acceptable levels,” he said.
Breen elaborated: “While it is accepted that legal costs would be front-loaded under such a protocol, it is to be hoped that there will be savings on costs in the longer term, consequent upon cases being settled at a much earlier (pre-litigation) stage.” There should also, he said, be significantly less reliance on counsel.
Questioning why legal costs in negligence cases had remained “stubbornly” high despite the prevailing deflation elsewhere in the economy, Breen said while some lawyers argued that such cases were complex to investigate and advance to trial, the taxation of legal costs system had recently begun to scrutinise and reduce the level of professional fees charged on the basis of “work done” rather than of a “percentage of the award or settlement”.

lloyd.mudiwa@imt.ie

By Lloyd Mudiwa.

The interim Medical Assessment Unit (MAU) and the Emergency Department at Cork University Hospital (CUH) are to remain operational during the construction of a permanent Acute Medical Assessment Unit (MAU) and Endoscopy Unit, the hospital has said.

According to CUH, the AMAU and Endoscopy Units will be located on the first floor of the Emergency Department (ED) building on the CUH campus.

The AMAU is listed in the HSE National Service Plan 2012 as one of the priority capital projects that are to be completed and/or to become operational this year.

“The interim Medical Assessment Unit is located adjacent to the proposed refurbishment site and directly below is the ED on the ground floor. Both areas shall remain live at all times,” the hospital stated.

The proposed space is currently occupied by Ophthalmology, according to the institution, which indicated that construction work would involve the demolition of some existing internal structures and the Ophthalmic theatre and the installation of new partitions to suit the proposed layouts.

On completion of Phase 3 of the new AMAU, moderate refurbishment will follow to facilitate the Endoscopy Service into the interim Medical Assessment Unit. Works will include the upgrade of two endoscopy procedure rooms and associated rooms. A number of rooms have been recently upgraded under Phases 1 and 2.

lloyd.mudiwa@imt.ie

Paul Connors, HSE

By Lloyd Mudiwa.

The Board of the HSE has emphasised the need to ensure close co-operation between the Communications Office in the Department of Health and the Executive’s Communications Directorate.

The HSE is to also implement a new Digital Communications Strategy, the Board heard.

The Board underscored the need for co-operation between the two offices, particularly at regional or area level and in relation to parliamentary and regulatory affairs. This followed a discussion by the Board following a presentation by HSE National Director of Communications, Paul Connors.

Connors presented on the role and structures of the HSE Communications Directorate, including the roll-out of the HSE Digital Communications Strategy, which will include an information website for the public on medical matters and a clinical information website, which would be available to all clinicians.

lloyd.mudiwa@imt.ie

Minister for Health Dr James Reilly

A major fundholder may be interested in investing up to half a billion euro in primary care in Ireland, the Minister for Health has suggested.

Addressing GPs at the ICGP AGM in Galway last weekend, Dr James Reilly said the expansion of primary care centres was a priority within the health capital budget.

While he said the Department of Health would be making a major fund available for the expansion of primary care centres, he added that Hawkins House was also “in negotiations with a major fundholder of a half a billion euro”.

“I can’t say too much more about that because there are at least two such funds who would be interested in investing in primary care in this country,” the Minister added in relation to the €500 million investment.

Dr Reilly stated that the HSE’s 2012 National Service Plan provided for 19 new primary care centres planned for completion in 2012 or early 2013.

However, he also said that despite the current financial situation, he believed that more doctors, physiotherapists, dentists and pharmacists needed to be encouraged to invest in these centres themselves and “have control over their own future”.

While “the last thing” he wanted was a situation where GPs did not have control over these centres themselves, he acknowledged that it may not suit everybody to invest in primary care centres and that the current economic climate represented “a real risk”.

Referring to the new GP contract, the Minister told GPs that the Department of Health was to meet shortly with the Departments of Jobs, Innovation and Trade and Public Expenditure and Reform, as well as representatives from the IMO and the Competition Authority, to discuss how the issues surrounding competition law could be progressed.

“I want to see a situation where we can progress meaningful discussions in relation to contracts and other issues in Croke Park and get by this block that we seem to have at the moment. I believe that where there is a will, there is a way and there is certainly a real will on my part to make this happen,” the Minister stated.

Dr Reilly also said that he wanted to see a strengthening of GP representation at management and executive level in primary care. “I think in the past what we had is the GP left out in the community working and healthcare being planned centrally without the inputs that should be there.

“We have a huge resource here in this room, and right across general practice in Ireland, that is not being tapped into and not being listened to. We want to address that,” the Minister said to warm applause.

By Dara Gantly.

The Medical Council has indicated that it is keeping “under review” a planned accreditation visit to RCSI Bahrain later this year.

Council CEO Caroline Spillane told Irish Medical Times that while the Council was committed to carrying out the visit in 2012, that commitment was something the regulator would have to monitor in light of the political unrest in the country. “We will keep it under review because, of course, we are aware of the fact that there is upheaval and unrest in the country and we have to have a mind to concerns over safety,” the CEO told IMT.

A team from Kingram House recently undertook four accreditation visits to universities in Malaysia that have links with NUIG, the RCSI, UCC and UCD.

See the full feature interview here.

dara.gantly@imt.ie

A GP registrar working with the Medicentre in Portarlington, Co Laois, was awarded first prize at the 2012 Quality in Practice (QIP) awards at the ICGP AGM held in Galway last weekend.

Dr Shónagh Mooney received the award for her research study entitled ‘Antipyretic use in children and the development of an information handout for parents, on antipyretic dosage, based on the weight of their child as opposed to their age’.

According to Dr Mooney, a large proportion of parents do not understand how to correctly manage a child with fever and as a result often gave too high, too low, too frequent or infrequent doses of antipyretics to their children.

In the community, children are given antipyretic medication based on their age as opposed to their weight, which is the measure used in the acute setting. When antipyretics are given based on the age of the child as opposed to their weight, however, Dr Mooney said this could result in the child receiving too little of the drug, which in turn could lead to more frequent presentations of pyrexial children in emergency departments (EDs).

In an attempt to address this gap in parental knowledge, the GP Registrar devised an information hand-out on the correct use of antipyretic medication based on a child’s weight rather than their age. This guide was then given to 40 parents presenting to the Laois practice with a child with a high temperature.

The vast majority of parents reported that the handouts were “extremely useful” and also helped reduce their anxiety levels regarding their child’s fever.

Of the patients who took part in the study, only one attended the practice and none presented to an ED in the days following their initial GP presentation, the study found.

There were two joint runners-up at the QIP Awards, which were sponsored by Promed. These were GP registrar Dr Niall Breen from Dublin for his study on the importance of recording the smoking status of patients in general practice and offering them support and advice on smoking cessation.

The second joint runners-up were Drs Killian McGrogan and Louise Campbell from the RCSI Mercer’s Medical Centre in Dublin, for their work on tackling the long-term use of benzodiazepines.

Dr Ray Walley, IMO GP Chair

By Gary Culliton.

The closing date for submissions under a new review of potential cuts under the Financial Emergency Measures in Public Interest (FEMPI) Act is next Thursday, May 24. The IMO will be making a submission shortly, the Chair of the union’s GP Committee Dr Ray Walley told Irish Medical Times.

FEMPI has reduced payments to a number of different health professionals, including GPs, with consultant psychiatrists who hold contracts with the Mental Health Commission also affected.

Under the current review, the Minister for Health may choose to make further cuts, increase payments or make no changes to the fee structure.

The financial model underpinning general practice is “close to collapse” because GMS fees are being “cut unilaterally under FEMPI”, the IMO CEO George McNeice said at last month’s AGM.

“The recession is causing private practice fees to fall and GMS patient demands to rise. General practice is creaking under the weight of the additional work which is being thrown at it. The GMS contract never envisaged GPs managing warfarin clinics, supervising phlebotomy services or running diabetic clinics, yet the HSE tries to force GPs to provide these services without any financial support or resources,” said Mr McNeice.

Meanwhile, the first meeting of the new IMO GP Committee is due to be held next Wednesday, May 23. Talks have not yet commenced with the IMO in regard to the text of the new primary care (free GP care) legislation due before the summer recess. “The IMO have not received a formal invitation to talks,” said new Committee Chair Dr Walley. “At the meeting, we intend to review the last year and look at the body of work ahead and plan for the coming year.”

Submissions on the latest review can be sent via email to the Department of Health at FEMPI2012@health.gov.ie or by post to FEMPI Review, Department of Health, Room 1.19, Hawkins House, Dublin 2.

gary.culliton@imt.ie