Mallow Primary Healthcare Centre: Building for the Future of Medical Care

1. 24th January 2014

2. Welcome

3. Agenda • Overview of Primary Care Centres • Development and Investment • Advances in Services • Potential for Future Development • Implications for Relationship Between Primary, Secondary and Tertiary Care

4. MPHC History • 2001 Primary Care Strategy • Blueprint for Primary Care Service Delivery • Teamwork - PCTs • HSE Primary Care Services/General Practice • New or Customised Buildings • Services To Patients • 3 PCT • History of GP Out of Hours Cooperation

5. MPHC • General Practices • The Red House Family Practice • The Medical Centre • The Cork Road Clinic • 2005 Negotiations with HSE • Construction March 2009 • Opened May 4th 2010 • Created 25 New Jobs To Date

6. MPHC • €25m Investment • 70,000 sq ft/320 Car Parking Spaces • 3 General Practices – 21 GPs – 30,000 Patients • The 4th Practice – 25 Specialist Services • HSE – 10 Services – 100,000 Patients • North Cork Community Mental Health • South Doc – GP Out of Hours Service • Pharmacy • 8 Ancillary Medical Services – Optician, Pain Clinic, Dentist • Cafe

7. Living Health Clinic • €11 m Investment • Opened 24th Nov 2008 • 30,000 sq ft • 8 GPs - 22,000 Patients • HSE Services • Public Access Radiology • CUMH - Obs and Gynae • 15 Ancillary Medical Services • Pharmacy • Cafe

8. Mission • Mallow Primary Healthcare Centre provides Caring, Considerate and Modern Primary Medical Care in a State of the Art Building • Open Access To All • 1,000 Patients a Day • 98% Satisfaction

9. Standards • UK Technical Memorandum • Building Standard • Efficiency • OHSAS 18001:2007 • Incorporates ISO and JCI • Management Standard • Accredited June 2010 • Reaccredited August 2011 and October 2012 • Board of Governance • Community Involvement

10. Research Educate Audit Develop(READ) • Full Time Researcher • Research and Ethics Committee • Academic, Legal, Community, Medical • Audit Processes and Practices • Multi Disciplinary Clinical Meetings • Active PCT Meetings • Community Involvement • Care of Elderly Week, One Small Change, Suicide Support, Stress Management, Healthy Heart, Dementia Friendly Building, Mallow Festival of Science

11. Research - EARLI • Aim assess the likelihood of a patient being admitted to hospital, and providing proactive annualized risk reduction for very high and high risk patients through GPs and HSE Working Together • 1,100 Letters – Elderly Patients – 80% Response • 69 Patients – High/Very High Risk • Result • Very High Risk - 50% Reduction • High Risk - 30% Reduction • National Saving €60m - €100m

12. Research – Skin Lesions • Aim -review the investigation and management of skin lesions performed in a GP practice over the course of one year and to compare this to the Primary Care Dermatology Society Skin Surgery Guidelines • Dermatological complaints reflect 12.4- 24% of presentations toGPs • 217 Patients in this Study • Conclusion - Of 35 biopsies, only 11 people(31.43%) ended up requiring referral to hospital specialists, a reduction of 24 on this sample or 68.57%. • 35 referrals = average 105 OPD visits • GP programme would save approx 83 visits • Saving €21,580 in this cohort alone

13. Research - Retinopathy Screening Total saving by carrying out Retinopathy testing in MPHC:500 OPD Visits€108,000

14. Paperless Warfarin Clinic • 4 step process, lasting 3 mins. • Near patient testing, capillary blood pippetted to warfarin machine, result automatically to CompleteGP and calculator with recommended result and label printed with each dose and next appointment date. • 5,440 Tests in 2012 • Average TTR - 66.9%. • Patient Satisfaction 70% gave 10/10. • Single patient complaint is cost.

15. Education in MPHC • CME/CPD continuous-ICGP recognised • Fellowship • GP Vocational Training • Cork • South West • Intern Training • UCC • Final Medicine Students-42+pa • 2nd Year Clinical Skills Training • UL • 3rd Year

16. Multi Disciplinary Training • PCT Training Course • Medical Secretary Training Course-Fetac 5 • Practice Nurse Training • Medical Undergraduate Training • Medical Postgraduate Training • HSE Training • Physio, OT, Psychology

17. Innovation-CompleteGP • Paperless GP Care • Computer assisted Warfarin Clinic-nurse led • Near Patient Testing-results integrated • IT Link to Nursing Home/other Services • Emergency Patient Record (HP+patent) • Electronic Prescription (McLernons) • Health Innovation Hub Collaboration

18. PCC Funding • Regional Diagnostic and Treatment Centre • Money Follows the Patient • To Work Properly Requires • Diagnostics • OPD/Community Specialist Clinics e.g. Diabetes • Possible Resources From Existing Budgets • Drug Budgeting • Laboratory Tests • We Can Deliver • Cutaneous and Subcutaneous Procedures, Dementia Care, Pre Hospital Screening, EARLI and much More

19. The Future • Cooperation Between PCCs • MPHC • Living Health • Ayrfield, Kilkenny • Waterford Health Park • Ability to Run New Services • Trial • Audit • IT • Infrastructure • Mallow Health Hub – Microcosm of Health Service-Rapid Area • 300 Residential Beds + 2 PCCs • EARLI Study

20. Thank You