THE establishment of elective-only hospitals as well as increased investment in primary care will take pressure off acute hospitals, which will need all the capacity they have to tackle any surge in Covid-19 cases amid the global pandemic, according to Cork GPs.
Budget 2021 is set to be unveiled tomorrow against the backdrop of the global Covid-19 pandemic, which has strained health services across Ireland.
Health funding has always been to the fore of discussions ahead of budgets in recent years but this year seems to have placed even more of a spotlight on what funding will be allocated to health services and when.
Speaking to The Echo, Cork GPs highlighted the need for additional capacity both in hospitals and in the community.
Dr Ronan Boland highlighted the need for extra hospital capacity to be signed off on now so that hospitals are not left struggling for beds and staff for years to come.
“I’ve seen some commentators asking why the capacity hasn’t been built in recent months,” he said.
“Some people were saying they thought we were locking the country down to increase capacity.
“But you can’t build hospital capacity in six months, it takes 10 years to do that,” he added.
“Take the National Children’s Hospital for example and I know there were specific issues there but it shows that, to go from the political decision to build a hospital to actually opening its doors, there’s a process of several years.
“Capacity gets built over years and it gets eroded over years and we have seen our hospital capacity eroded, notwithstanding the fact the population of this country has grown over the past two decades.
“Decisions need to be made now to increase that capacity - not for tomorrow because it won’t be here by then - but so we have it going forward five, ten years into the future, because we’re clearly going to need it.”
Meanwhile, Bantry GP Dr Paul O’Sullivan said that the Covid-19 pandemic has highlighted, more than ever, the need for elective-only hospitals to ensure that as much activity as possible can be kept out of acute settings and emergency departments.
Cork has been promised an elective-only hospital as part of the Ireland 2040 plan but amid the global pandemic, talk of the hospital has gone rather quiet.
“In the UK, they have the operative hospitals that cater for the hip surgeries, cataract surgeries and much, much more,” said Dr O’Sullivan.
“This would ensure that patients undergoing medically straightforward treatment can be kept away from ‘normal’ hospitals.
“This would allow for waiting lists to be tackled and it would also free up capacity in acute hospitals to deal with emergency cases, or in the current climate, increased Covid-19 cases,” he added.
“These elective hospitals are particularly practical for the likes of cataract operations.
“I remember being at a medical charity eye clinic in Nepal one day where between 100 and 150 people were operated on in a single day.
“All it was was a simple bench and basic operative tools and all of the people were operated on successfully.
“This can be done but it will require a change of mind and systems.”
Dr O’Sullivan also said that further investment in primary care, including general practice, can play an important role in ensuring hospitals are not placed under severe pressure from routine issues as they attempt to tackle a global pandemic.
“Covid is going to be with us for at least another year plus,” he said.
“We may have to look at how to use limited resources in the best possible way and primary care needs to be examined in that regard.
“Primary care deals with more than 90 percent of all patient contacts and GPs are highly skilled,” he added.
“For example, in dermatology, GPs can see patients in surgeries and deal with the majority of dermatological conditions even performing minor surgery to remove lesions and so on.
“Putting extra funding into primary care in structured interventions can have a multiplying effect and provide more bang for your buck, rather than just throwing it at hospitals.
“It can take the pressure off the acute sector in that regard and any investment in primary care would help recruit GPs as well.”
Addressing the issue of waiting lists, Dr O’Sullivan said they are one of the main challenges facing the health sector today and that Covid-19 will only make them worse.
“Looking at the outpatient waiting lists now, it’s clear that Covid-19 is going to have a huge impact on that and we’re seeing it already,” he said.
Dr O’Sullivan said people are not being seen or they’re being seen in virtual clinics which he said is not as good as face-to-face appointments.
“Covid is already having a huge impact on outpatient waiting times and my sympathy is with the HSE because, to have an impact would take out-of-the-box thinking,” he added.
“An expansion of the National Treatment Purchase Fund could help or even perhaps purchasing a private hospital and turning it into an elective hospital to tackle waiting lists.
“That might be the only way to do it.”
Dr O’Sullivan admitted it is frustrating for GPs to see patients attending their service again and again seeking answers in relation to consultant appointments when there is no positive answer to give them.
“Many Cork GPs would see their patients 30 to 40 times before they’re seen by a consultant,” he said.
“The main problem is the fact that waiting lists are so long now.
“In rheumatology, for people with arthritis, the current waiting time is around 19 months just to be seen, never mind investigated or treated.
“That means GPs are the only point of care or treatment in reality, for their patients because it’s so difficult to see a consultant.
“Obviously, private care can be different but not everyone can afford that avenue.”
Dr O’Sullivan also highlighted lengthy waiting times for those awaiting orthopaedic or ophthalmology appointments.
“I have a patient who is waiting three years to be seen by the consultant in ophthalmology,” he said.
“I have written letter after letter but nothing has changed.
“I get regular letters from his optician telling me his vision is deteriorating every time he is reviewed but my hands are tied,” he added.
“It’s a similar story in orthopaedics where people could be waiting six to 12 months to be first seen by the consultant.
“Any operation or treatment could take another six to 12 months plus and that’s for routine treatments.”
Dr O’Sullivan also highlighted the difficulties GPs face in accessing routine tests, and the need for change in that regard.
“GPs are lucky to get X-rays organised,” he said.
“We have access but the waiting times are from two to four weeks even for semi-urgent cases.
“We have only limited access to ultrasounds and we can’t organise CT or MRI scans unless they’re done privately and a patient is willing to pay for them,” he added.
“These are tests that would speed things along if patients need to see a consultant.
“What usually happens is a patient sees a consultant, which can take six months, and the consultant decides that scans need to be carried out.
“These scans can take another several months.
“If those scans could be accessed by GPs, it would save six months or more.”
Dr O’Sullivan also highlighted the need for funding to support general practices in establishing and maintaining IT systems as well as for administrative staff.
“Nearly all G Ps fund their own IT systems and it can be quite costly,” he said.
“To have even a support grant for GPs to set up or update their systems would be welcome.
“GP practices can’t function now without IT support because most of our referrals are done electronically,” he added.
“GPs need IT systems to function these days but those systems are becoming prohibitively expensive because of the cost.”