Or Carol Mcquillan Bsc ( Hons), Researcher and Software Developer
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Feasability study for the provision of cross border out of hours GP services Item Type Study Authors Moore, Adrian;Co-operation and Working Together (CAWT) Publisher Impact Publishers Download date 30/09/2021 23:42:05 Link to Item http://hdl.handle.net/10147/244585 Find this and similar works at - http://www.lenus.ie/hse , -.j.'i~ 'Inn>l"'lq "" V""'no l..lltUfl .( ...~ '_>.<;,--[Jo .i)fU>.'!"!\ 1"""11:< \}". ,-~;, " ';~""~':~_,, __"': .~ ...-:;._ .. :,,;-, :::,;" ,;, ;.;;.;c;",;",,:,,:, :;,;)~.,,~}J"i :l "x'::-f ;:.~.:. :t ':~: ~ , .'--::.- :~%::~~ :';:,::;: ';~i x: :O;,;:@::';~~: .:-., :t ; :::~~:::: ,r.;~"" -:~.: .?: "",' .. '-~ :'om'.: ,",' .', , :}:: ;:% '. -', ~ :S :",:' ;,;W'=- m q ::;;:: • ./w -.',' . ~::~::;4.. : . ::w:;::;_, _,w. ::3t<. '---'.~ , ::% :;:;:;~: Feasibility Study for the provision of Cross Border Out of Hours GP Services Authors: Adrian Moore, Carol McQuillan, Stephen McAlister, Joanna Freeman, Andrew W Mu rphy, Catherine Loughrey, Scott Brown © CAWT ISBN 0 948154 01 2 Printed & Published by Impact Publishers Co leraine & Ba llycastle Feasibility Study for th e provision of Cross Border Out of Hours GP Services CONTENTS page Foreword 3 Acknowledgements 4 Executive Summary 5 1. Introduction 7 1. 1 Background 7 1.2 A Socio-Economic Profile of the Irish Cross-border Region 11 2. Methodology 15 2.1 Terms of Reference 15 2.2 Geographical Issues 16 2.3 Tech nical Issues 16 2.4 Professional and Business Issues 16 2.5 Methodologies Employed 17 3. Geographical Issues 19 3.1 Objectives 19 3.2 Methods 19 3.3 Data 20 3.4 Current 'within jurisdiction' primary care centre catchment a rea~ 21 3.5 Cross border 'irrespective of jurisdiction' primary care centre catchment areas 23 3.6 Areas which would be suitable for cross border out of hours arrangements 24 3.7 Popul ations and estimated number of people residing in areas that are closer to a primary care centre outside their residential jurisdiction 25 3.8 Gains, loses and net differences in catchment populations for each primary ca re ce ntre 26 3. 9 Con clusion 26 4. Technical Issues 28 4.1 Objectives 28 4.2 Methods 28 4.3 Technical eva lu ation of current call handling system and procedures employed by co-ops 29 4.4 Proposed Solution - Model for Cross Border Out of Hours Calls 33 4.4.1 Technical Architecture 33 4.4.2 Integrating GIS output into the ADASTRA system 34 4.5 Overview of Recommended Cross Border Ca ll Handling Procedures 35 5. Professional and Business Issues 39 5.1 General Professional and Business Issues 39 5.2 Objectives 39 1 5.3 Methodology 39 5.4 Medical Registration 40 5.5 Nursing Registration 41 5.6 Medical Indemnity 41 5.7 Procedures for dealing with cross border complaints 43 5.8 Attitudes of the Medical and Nursing Unions 44 5. 9 Premises Insurance 45 5.10 Hospital and Crown Indemnity 45 5.11 Ambulance Services 46 5.12 Patient Advocate Groups 47 6. Pharmacy Issues 48 6.1 Objectives 48 6.2 Methods 48 6.3 Current provision of Out of Hours ph armacy services 48 6.4 Evaluation of Options for Cross Border Co-a ps 49 6.5 Operational Issues 51 7 Additional Workload and Demand Issues 53 7.1 Objectives 53 7.2 Data Collection 53 7.3 Methodology 54 7.4 Estimating the number of people from NI who would be offered the choice of attending a RaI out of hours ce ntre in a one year period 55 7.5 Estimating the number of people from the ReI who wou ld be offered the option of attending a NI out of hours centre 57 7.6 Workload estimates for a one year period 60 8 Financial I ssues 62 8.1 Objectives 62 8.2 The current structure and fi nancing of co-ops in the study area 62 8.3 Comparison of financial systems 63 8.4 Important issues for a cross border service 64 8.5 A financial model for cross border transactions 66 9 Conclusion 68 9.1 Summary of Geographical Research 68 9.2 Summary of Technical Research 69 9.3 Summary of Professional/Business Issues 69 9.4 Overall Recommendation 69 9.5 Recommendations for a Pilot Scheme 69 10 Operational Plan for Pilot Scheme 72 Appendices 75 Appendix I - Profile of Research Team Members Appendix II - Attendees of Introductory Feasibility Study Workshop Appendix III - Recommended Pi lot Area Maps 2 Feasibility Study for the provision of Cross Border Out of Hours GP Services FOREWORD However, on the basis of the research and various analyses, the In June 2001 CAWT conclusion is that the introduction commissioned a of a cross border G.P. out-of-hours study to be carried service is indeed feasible. Based on out by the University the r eport's recommendations, of Ulster, the National CAWT is now in a position to develop University of Ireland, a pilot scheme, which will be Ga lway and implemented for a trial period. Causeway Data Communications Ltd., to examine CAWT beJieves that such a service the issues necessary for has tremendous potential to improve consideration before cross border access to health care for inhabitants out-oF-hours arrangements could of the border region. One of its take pl ace. The results of this study many strengths lies in the fact that are now complete and are contained it adopts a locality-based approach in this report. to needs assessment and service delivery and indeed might be seen The research reveals that of the one as a first stage in the wider m illion inhabitants in the CAWT development of improving regional region approximately 65,000, across access to services, regardless of the length of the border, are closer jurisdiction. to G.P. out-of-hours services in the opposite jurisdiction. The report also I would like to congratulate all those highlights that over 70% of this who have contributed to this population live in areas that can be excellent study. CAWT will maintain classed as socially deprived. If a its support for this and for other patient were free to travel across the innovative developments in border to see a GP out-of-hours, the healthcare provision, as we continue travel distance, depending on to work for the benefit of our location, would be considerably resident populatians. reduced. Mr. Paul Robinson A number of detailed legislative, Director General of CAWT financial and practical issues have been raised in the feasibility study. It IS also c lear that the implementation af a cross-border service would require considerable organisation and preparation. 3 ACKNOWLEDGEMENTS The authors would like t o acknowledge the assistance of all of those who contributed to this project. In particular, we would like to thank Fra nces McReynolds, Judith Doherty and the staff at the CAWT Resource Un it, The CAWT Secretariat and members of the CAWT Out of Hours Sub- Group, namely Tadhg O'Brien, Eugene Gallagher, Noel Scott, Eddie Ritson and Dr. Robert Thompson. We are also indebted to all of those who participated in the va rious workshops throughout the duration of t he project (named in the Appendices), and especially to Dr. Brian Sweeney, Eug ene Dunn, Sharen Fu lton, Mark Armstrong, Joy Synnott, Ka te Mu lvenna and Martina Ralph for t heir valuable assist ance and advice. We were amazed at the level of enthusiasm, support and encouragem ent we received f rom the vari o us health service professionals on both sides of t he border, with whom it has been a pleasure to work. 4 Feasibility Study for the provision of Cross Border Out of Hours GP Services EXECUTIVE SUMMARY and operational issues and a number of basic principles as guidelines, a A multi-disciplinary team of project management plan and academics, medica l professionals methodology was formulated, which and techn ical experts from the divided the key research tasks into University of Ulster, the National three d isti nct sections, University of Ireland, Galway, and Geographical, Professional and Causeway Data Communications Business, and Te chnical. Ltd., Colera in e, was commissioned by CAWT to undertake a feasibil ity A Geog raphic Information Systems study into the provision of cross approach was adopted to identify border out of hours primary care and quantify the areas and services in the Irish border region. populations in the border areas who The project, initiated through the could potentially benefit from the Primary Ca re sUb -group's Primary availability of a cross border out of Care Project 'Developing Primary hours service. It was shown that Care across Borders and circa. 65,000 people would be Boundaries', began in May 2001 and eligible for the service on the basis was completed in May 2002. This of living closer to an out of hours report presents the findings and centre on the other si de of the recommendations from the study. border. Further analysis revea led that the majority of those eligible The basic t erms of reference for the reside in areas t hat are deSignated study were 'to research jOint working as being materially deprived. and co -operation between professionals on a cross-border GP From the technical perspective, an ou t-of-hours arrangement and analysis of the current protocols, produce an operationa l plan processes, software and network addressing the organisational and solutions used by the various co management issues, which need to operatives in th e region was be considered before cross-border undertaken. It was fortunate that all co-operation can take place'. The of the co-operatives use the same study focused only on patients ADASTRA software as this faCi litated travelling across the border to seek the development of an inter care in primary care centres.