The impact of rising productivity demands and workload on continuity of care was raised at the IMO AGM.
The growing pressure within primary care, in particular, was a major theme on the opening night of the conference in Killarney.
“Practically, I think a lot of practices are at a point where they are restrained by buildings and premises,” Dr Austin Byrne, a GP based in Tramore, Co Waterford, told the Medical Independent (MI).
“So we need to have some way to incentivise or facilitate the [improvement] of the physical infrastructure in order to house more people.”
Dr Byrne, a member of the IMO GP committee, was one of the speakers during a session on measuring productivity in healthcare.
In his presentation, Dr Byrne outlined some of the challenges facing general practice.
He told MI the IMO’s €210 million agreement with Government in 2019 to reverse cuts imposed through Financial Emergency Measures in Public Interest legislation has been positive.
“Practices are now scalable entities,” Dr Byrne said.
However, greater support is now required to allow for the development of primary care infrastructure, he added.
Dr Byrne said there should also be a “rational expansion” of the GP contract.
This would include acute care and “the chronic care side, which needs to be expanded and enhanced”.
“And then we need to have to cover the unplanned tasks… that tend to creep in insidiously,” said Dr Byrne.
He said these tasks – which include requests from outpatient departments, public health nurses, and other agencies such as Tusla – end up being absorbed into general practice in an unstructured manner.
Dr Byrne emphasised the need for general practice to “protect what we have, scale what we have, grow what we have”. He said the current model is working and must be maintained, warning against the danger of letting it “wither”.
At the same time, he stressed the need to expand services quickly in response to demographic pressures and rising patient demand. However, he cautioned that this growth must not come at the expense of continuity of care.
“So that we don’t end up with mega centres, where patients are interacting with multiple different providers [and] different clinicians.”
During his presentation, Dr Byrne highlighted the strong clinical evidence supporting the importance of continuity of care for patients.
He outlined concerns that “additional workload” and growing productivity demands on GPs would have a negative impact in this regard.
“The notion of continuity is a metric that has always been measured by-the-by,” Dr Byrne told MI.
“But it is actually a valid clinical sign. If you have a high continuity index, better stuff happens. People die less often; people go to hospital less often.”
In addition to the clinical benefits, he pointed out that supporting care at a lower level of complexity generates financial savings for the health service.
Also speaking during the session, the new IMO President Prof Matthew Sadlier said emergency department crowding was not only a marker of hospital inefficiency, it affected “the ability to provide clinical care”.
He pointed to the “lack of a centralised bed management” system across hospitals and an “inefficient referral process”, which is still overly reliant on handwritten notes.
Prof Sadlier added that the “significant” amount of time that doctors and other healthcare workers spent on mandatory training also impacted on productivity.
Ms Danielle Jefferies, Senior Policy Analyst with the King’s Fund in London, UK, addressed the session on the experience of the NHS in England.
She said statistics showed that a rise in productivity had stagnated in the years prior to the Covid-19 pandemic.
Then, during the pandemic, productivity “fell off the cliff”, according to Ms Jefferies.
However, since the crisis ended, she said “there has been a slow recovery in productivity levels”.
Among the general impediments to productivity in NHS England, Ms Jefferies highlighted the under-investment in health capital infrastructure over recent decades.
Leave a Reply
You must be logged in to post a comment.