We need primary care services fit for our changed society

John Tingle discusses a report from the Patients Association on provision of and access to primary care services.

A dermatology outpatient waiting list initiative

Skin disease is the most common reason for people to present to their general practitioner (GP) with a new episode of disease. In April 2010 there were estimated 23,000 patients on dermatology outpatient waiting lists in Ireland, including almost 11,000 patients waiting over 6 months. We analysed the data of 200 dermatology outpatient visits scheduled under an initiative to target patients waiting more than 120 days for a new dermatology outpatient appointment. There were 171 (85.5%) patients seen, 29 (14.5%) patients did not attend the appointment. The data from 161 patients seen under the initiative was included in the analysis. Skin lesions accounted for 81 (50%) referrals, of these 71 (44%) patients had benign skin lesions and 10 (6%) patients were considered to have suspicious skin lesions. There was no case of malignant melanoma. After the initial consultation, 66% (106) of the patients were discharged to their primary care physician.

Introducing an annualised contract for a consultant team in a district general hospital

The majority of physicians work a weekly timetable consisting of programmed activities (PAs) defined by the consultant contract. This paper describes the implementation of an annualised contract within a gastroenterology department, which is located across two district general hospital sites within the same trust. The perceived benefits of the system include the introduction of a new out-of-hours emergency endoscopy service, more efficient backfilling of vacant endoscopy lists and greater transparency of work patterns and workload between colleagues and within the trust.

Use of a structured palliative care summary in patients with established cancer is associated with reduced hospital admissions by out-of-hours general practitioners in Grampian

OBJECTIVES

Palliative care summaries are used by general practices to provide structured anticipatory care information to those providing care during the out-of-hours period. We hypothesised that the availability of a palliative care summary for individuals with established cancer would influence emergency hospital admission during the out-of-hours period.

METHODS

Each consultation with Grampian Medical Emergency Department (GMED) is recorded on the ADASTRA software system and the nature of the consultation is Read coded. We retrospectively reviewed consultations between 1 January 2011 and 31 December 2011 which had been coded as 'neoplasm' or 'terminal care'. The availability of a palliative care summary on ADASTRA and admission status were recorded. χ(2) Test of association was performed. Binary logistic regression was used for multivariate analysis exploring the effect of a palliative care summary on admission, while adjusting for important confounders.

RESULTS

401 patients with established cancer were identified who had presented to GMED in 2011. 35.7% had a palliative care summary available on ADASTRA. Of the 401 contacts, 100 patients were admitted to hospital. Not having a palliative care summary made admission significantly more likely; χ(2)=12.480, p=0.001. (OR 2.425, 95% CI 1.412 to 4.165).

CONCLUSIONS

Availability of a structured palliative care plan can aid decision making in the out-of-hours period and prevent unplanned hospital admissions.