Community services to grow

Greg Baxter spoke to Mr Jim Joyce, CEO of Point of Care, a company whose specialist infusion clinics spare patients from making trips to hospital.
The opening of the second Point of Care clinic – a specialist nursing infusion centre in west Dublin marks the beginning of what is expected to be a rapid national expansion.

Once in place, 20 centres will serve up to 10,000 patients per year. According to the CEO of Point of Care, Mr Jim Joyce, the company’s goal is that the centres will be within an hour’s drive of 85 per cent of the population.
The centres will treat patients who need infusion services for critical and chronic diseases such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, multiple sclerosis and osteoporosis. While patients will be treated in the community, they will remain under the supervision of consultants.
Mr Joyce, originally from Boston, worked for several years in the pharmaceutical industry here before noticing a large gap in the Irish market – an absence of modern, specialist nursing community clinics for people, needing infusion services, who had difficulty accessing larger acute centres.
The specificity of the niche says a great deal about the private sector’s role in the delivery of healthcare – a role that, Mr Joyce suggested, is being defined as much by quiet successes as controversial failures.
Point of Care has no contract with the HSE and is currently only treating patients with private healthcare insurance, but talks are under way to work with the HSE and Mr Joyce expects progress in that area within the next 12 months.
He told Irish Medical Times that the Point of Care model remains unique, for the moment, because it will be the only specialised nursing community care service that is standardised across the country.
h4. Not fixed to facilities
When the network is complete – Mr Joyce expects that all 20 clinics will be operating within two years – up to 80 nurses will be working at them. Some may be part-time, but all will form a national team that will not be fixed to facilities, but can move from one to another.
“The most important thing is to make sure that you can hire top-quality specialist nurses,” he said.
His plan highlights one of the fundamental tensions inherent in a robust private sector working in partnership with the public sector – competition for top staff. “Point of Care will be very different than a hospital environment, and it could appeal to certain nurses who don’t want to work at night, or who want more flexibility,” he said.
Point of Care’s uniqueness is its ambition of scope and its philosophy of standardisation. The facilities are housed in existing medical space rather than constructed from the ground up, which cuts down on capital spend. Patients get care in a room with four infusion beds.
“Every location must meet strict criteria before being chosen,” said Mr Joyce. It must be easily accessible. There must be parking spots available. The building must be a clean, modern facility with wheelchair access.
Most importantly, the Point of Care clinics must be co-located with a GP who has agreed to work with Point of Care. This gives nurses a medical backup in case of emergency.
“We’re looking for innovative GPs to work with – GPs who are open to new ideas,” he said. Mr Joyce added that Point of Care is not interested in a primary care model where GPs are salaried employees, but independent GPs working beside the infusion centre.
Once a location is picked, the facility itself must meet what he called the Point of Care Standard. The guidelines ensure not only that quality remains high, but that the model can be duplicated from one centre to the next. That similarity makes it possible for nurses to work in many centres.
Critically, he said that Point of Care can provide infusion services cheaper than an acute hospital, adding that moving people from the acute sector to the community improves quality of life.
“We can do it cheaper. We’ve looked at the cost to the public system. Our nurses can move from clinic to clinic, we’ll make more efficient use of space and resources, and our facilities are already built.
“We’ve compared our cost for infusion services for a rheumatoid arthritis patient, which is €2,000 per year, with the cost for those services in a hospital, which is €3,000,” he said. Point of Care would pass that savings to the HSE, if a service level agreement were reached, he added.
h4. Less stressful
Mr Joyce said the Point of Care network could take up to 1,000 patients out of the public system per year. An infusion patient can require treatment every four weeks, which means a dozen hospital visits could be moved into the community, possibly at a more accessible location, and in an environment that is less stressful for the patient. “Visits to the hospital remind patients of the traumatic nature of their disease,” Mr Joyce explained.
He said Point of Care could expand its services to other areas that could be done by nurse specialists — including TB tests and follow-up visits. He had no doubt that a field of competitors would emerge when the benefits of a single-design, duplicatable model of community care were realised.