Minutes of the meeting of the Western Health Board 5th June 1973

Item Type Meetings and Proceedings

Authors Western Health Board (WHB)

Publisher Western Health Board (WHB)

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WESTERN HEALTH BOARD

Telephone: 7631 HEADQUARTERS, MERLIN PARK REGIONAL HOSPITAL, GALWAY.

5th June, 1973.

To: Each Board Member:

Re: Report of Working Party on Psychiatric Nursing Services of Health Boards

Dear Member,

I enclose, for your information, copy of the above report received today from the Minister for Health. Copies are also being distributed among the Nursing Staffs of these hospitals.

Yours sincerely,

E. Hannan, Chief Executive Officer.

" corresponding upward

od)u«t»ont in tho r*vU«d lovel of not expenditure

at notified for tho currant financial year.

/2 b6RO slAince An lARtAm WESTERN HEALTH BOARD

Telephone: Galway 7631 HEADQUARTERS, MERLIN PARK REGIONAL HOSPITAL, GALWAY.

12th June, 1973.

To: Each Member of the Board:

Re: Future of County Hospital, Roscommon - Acute Hospital Services

Dear Member,

A Special Meeting of the Board to consider the above matter will be held in the Boardroom here on Monday next, 18th June, at 3.00 p.m. You are hereby requested to attend. Copy of my report enclosed herewith, which, at this stage, should be regarded as strictly confidential, and not for publication before time of meeting.

Yours sincerely,

&b^^ &vj • E.Jet Hannan , Chief Executive Officer.

accordingly anticipated a corresponding upward

adjustment in the revised level of net expenditure

as notified for the current financial year.

/2. b6no slAmce AM lARtAm WESTERN HEALTH BOARD

Telephone: Galway 7631 HEADQUARTERS, MERLIN PARK REGIONAL HOSPITAL, GALWAY.

To each Member of the Board.

18th June, 1973,

Dear Member, I enclose one of each of the publications referred to below. References were made to these in the Plan for the Development of the Health Services adopted by the Board at its meeting on 29th May, 1973: -

(1) Report of the Consultative Council on the General Hospital Services published in I968.

(2) Report of the Commission of Enquiry on Mental Handicap published in 1965. (3) Report of the Commission of Enquiry on Mental Illness published in 1966. (4) Report of Inter-Departmental Committee on the Care of the Aged published in 1968.

Yours sincerely, J? HftAhJMAS E. HANNAN, Chief Executive Officer.

accordingly anticipated a corresponding upward adjustment in the revised level of net expenditure \ as notified for the current financial year. n. b6no slAirrce An lARtAm

WESTERN HEALTH BOARD

Telephone: Galway 7631 HEADQUARTERS, MERLIN PARK REGIONAL HOSPITAL, GALWAY.

26th June, 1973.

To: Each Member of the Board:

^ Dear Member,

I desire to inform you that the next meeting of the Board will be held at the District Hospital, Ballina, on Monday, 2nd July, 1973, to consider Agenda as set out hereunder.

The Members will assemble there at 3.00 p.m. to visit the hospital prior to the meeting.

You are hereby requested to attend.

Yours faithfully,

-e ^/ E. Tlahnan, Chief Executive Officer.

AGENDA

1. Opening Prayer. 2. Verification of Minutes of: (1) Special Meeting of 29th May, 1973 (Copy herewith). (2) Monthly Meeting of 5th June, 1973 (Copy herewith). (3) Special Meeting of 18th June, 1973 (Copy herewith). 3. Resignation by Dr. M. J. Mylotte of his membership of the Board 4. Calvary Hospital, Galway -Future, of Maternity Department - Report of Sub-Committee, dated 25th June, 1973, herewith.

/2....

,!g~her than the UJPff^MWHHpOTil accordingly anticipated a corresponding upward adjustment in the revised level of net expenditure as notified for the current financial year.

/2 I b6RO slAinue An lARtAm

WESTERN HEALTH BOARD

dephone: Galway 7631 HEADQUARTERS, MERLIN PARK REGIONAL HOSPITAL, GALWAY.

- 2 - 5. Regional Hospital, Galway - Visiting hours. 6. Increased Rates: (a) Home Assistance.

(b) Disabled Persons' Maintenance Allowances. (c) Infectious Diseases Maintenance Allowances. 7. Boarded-Out Children.- Increase in Allowances. 8. Grants for the provision of Radio-Telephones for Doctors in certain rural areas. 9. Reports of Meetings of Standing Committees - Copies of Minutes herewith. 10. Chief Executive Officer's Progress Report: (1) "Choice of Doctor" and "Choice of Pharmacist" Schemes. (2) General Medical Services::- Bangor-- area.

(3) Ballina District Hospital - Post of Medical Officer.

********

iy.. accordingly anticipated o corresponding upward adjustment in the revised level of net expenditure as notified for the current financial year.

/2 BORP SLAINTE AN IARTHATR

Minutes of Monthly Meeting of Western Health Board held at 4.00 p.m. on

Tuesday, 5th June, 1973, at St. Brigid's Hospital, .

Present: Councillor T. King - Chairman - who presided.

Other Members: Messrs. P. C. Bresnihan, E. Carey, Miss D. Casey, Messrs. P. Concannon, J. , Mrs. M. Croffy, Messrs. J. Cullen, M. J. Dyar, M. J. Egan, P. Flynn, L. Hanniffy, E. Haverty, P. D. Joyce, J. R. Lenehan, M. D. Lyons, M. J. McLoughlin, J. M. Mannion, J. P. O'Callaghan, P. 0 Cathain, J. P. O'Donnell, P. D. Power, M. Ryan and J. J. Tobin.

Apologies; Mr. T. 0 Baoill and Councillor D. O'Rourke.

In Attendance: Mr. E. Hannan, Chief Executive Officer; Messrs. T. P. Keyes, Programme Manager, General Hospital Care; P. McDaid, Programme Manager, Community Care; J. Moran, Finance Officer; Dr. J. R. Shea, R.M.S., St. Brigid's Hospital, Ballinasloe, Mr. T. P. Stack, Secretary, St. Brigid's Hospital, Ballinasloe; Messrs. J. Fitzmaurice, Section Officer, and J. O'Leary, Secretary.

Opening Prayer: The opening prayer was recited in Irish by the

Chief Executive Officer.

Minutes: Minutes of Monthly Meeting held on 7th May, 1973,

copies of which had been circulated, were adopted

on the proposal of Senator M. D. Lyons, seconded

by Councillor M. Ryan, and then signed by the

Chairman.

St. Brigid's Chief Executive Officer recorded his thanks and Hospital. appreciation to all who had helped to curtail the Ballinasloe - Fire serious outbreak of fire in St. Brigid's Hospital, Outbreak: Ballinasloe (New Buildings) at 12.40 p.m. on

Friday, 1st June, 1973, all sections of the Staff,

i.e. medical, nursing, maintenance, farm and

domestic. He wished to record a special word of

thanks to Mr. Damien Martin, Machinery Contractor,

Lusmagh Road, Banagher, Co. Offaly,

whose prompt and courageous action in demolishing

the link corridors with his bulldozer prevented

the fire from spreading. He expressed

/2. - 2 - appreciation of the prompt response and excellent work done by the fire brigades from Ballinasloe,

Loughrea, , Galway and Athlone for a job well done, with a special word of thanks to the

Station Officer, Ballinasloe Fire Brigade. The

Members had visited the affected building prior to the meeting and had seen how ramps constructed and doors widened during the past year had facilitated the evacuation of the 241 patients, who had been accommodated in these buildings. Insurance cover of all the Board's property had been revised recently. The Insurance Assessor, Architect and Consulting Engineer had already visited the site, inspected the damage and would report in due course. Thirty-five (35) of the evacuated patients were transferred to St. Patrick's Hospital,

Castlerea, and others placed throughout St. Brigid's

Hospital. He made a special appeal to relatives to take home any patients who were fit to be discharged.

The Board had recruited a Fire Prevention Officer,

Mr. F. Hayes, who had taken up duty on 1st June,

1973, the day of the fire outbreak in St. Brigid's

Hospital, Ballinasloe, and he would proceed to carry out a review of the fire precautions necessary in the Board's institutions without delay, which would be his first priority. While the County

Councils were the Fire Brigade Authority, it was the Board's responsibility to implement the advice given by the Chief Fire Officers, and ensure adequate fire precautions.

Mr. Gabriel Brennan, General Manager, Irish Public

Bodies Mutual Insurances Ltd., the Board's Fire

Insurers, was also present, and joined in the

/3 - 3 -

tributes paid to all who helped to control the fire.

The Chairman and Members also expressed their

appreciation to all the Staffs and Mr. Damien Martin

for their work, and Dr. J. R. Shea suitably

acknowledged.

Overdraft It was proposed by Senator d. M. Mannion seconded Accommodation - by Dr. J. J. Tobin and resolved:- Quarter ending 30th "That we hereby authorise the raising of Overdraft September, 1973: Accommodation in the sum of one-million-five-hundred-

thousand-pounds (£1,500,000) for the period ending

30th September, 1973, pursuant to Section 33 of the

Health Act 1970."

St. Brigid's Hospital, It was proposed by Councillor Mrs. M. Croffy, Ballinasloe - Disposal! seconded by Senator M. D. Lyons and resolved:- of Plot of Land to "That we hereby consent to the disposal of a plot Galway County Council for Road Improvement of land consisting of 17 perches or thereabouts Purposes: situated in the of Portnick, County Balway,

to Galway County Council for road improvement

purposes on the terms set out in the Statutory

Notice dated 11th May, 1973, circulated to each * Member."

_Butter Subsidy Copies of Press Release issued by the Government Scheme: Information Bureau on behalf of the Department of

Social Welfare on 25th April, 1973, were distributed

to each Member. The terms of the scheme were noted

and the Chief Executive Officer stated he would

convey to the appropriate Minister the views

expressed that the surplus butter to be made

available to recipients of Social Assistance, should

be Irish butter and that the allowance of one pound

per month be increased to one pound weekly.

Standing Committees Minutes of Meetings of Standing Committees, copies Reports frnm of which were circulated to all Nembers on 29th Meetings; /A - 4 -

May and 1st June, 1973, were considered and noted

as follows:-

(1) Psychiatric and Geriatric Care Meeting of 9th

April, 1973.

(2) General Institutional Care Meeting of 1st May,

1973.

Progress Report Chief Executive Officer reported as follows:- from Chief (l) General Medical Services "Choice of Doctor" Executive Officer: and"Choice of Pharmacist" Schemes:"

The following was the position in regard to

the number of persons covered by General

Medical Service Cards on 30th April, 1973:

Card Persons Population % % Covered Holders Covered Covered 30/9/'72

Galway 31,244 62,934 149,223 42.2 30.8

Mayo 28,098 60,900 109,525 55.6 43.5

Roscommon 12,032 23,285 53,519 43.5 37.1

Total 71,374 147,119 312,267 47.1 36.8

30/9/'72 57,254 114,534

The Members would note the increase in the numbers

covered by Medical Cards since 30th September, 1972,

and there was no abatement in the number of new

applications. A review of card holders in Galway

City now underway would probably reduce the numbers

covered. The position with regard to vacant

posts for doctors under the Scheme in the Board's

area was as follows:-

/5 - 5 -

(a) :

Candidates for vacancies in Williamstown,

Portumna and Woodford would be interviewed

within the next two weeks.

(b) :

(i) Knocknalower:

This vacancy was advertised on a number

of occasions without success and the

position was still under review.

(ii) :

% A vacancy due to arise in Castlebar had

been advertised, the closing date being

14th June, 1973.

(c) COUNTY ROSCOMMON:

(i) Ballyleague:

The candidate selected was due to take

up duty on 30th June, 1973.

(ii) Castlerea:

The date of taking up duty by the

|^ recommended candidate would be fixed

following the outcome of the Woodford/

Portumna competitions.

Returns from the General Medical Services Payment

Board for March 1973, gave the following expenditure

in respect of this Board's area to date:

PAYMENTS TO:

Doctors Pharmacists Total £ £ £ 83,162 134,187 Month of March 1973: 51,025

333,760 538,443 Oct. '72 - Feb. '73: 204,683

Gross Total for £416,922 £672,630 Si:< Months: £255,708

u - 6 -

The yisiting Rate for March was 5.8 per annum which

was joint fifth of the eight area Health Boards,

the average for the State being 6.3. He was

arranging for the preparation of returns showing

the comparative costs of the new Scheme as against

the cost of the Old Dispensary General Medical

Service which ceased on 30th September, 1972.

(2) Grants for provision of Radio Telephone Equipment for Doctors in certain Rural Areas:

Programme Manager, Community Care, had made

enquiries regarding the provision of a suitable

type radio telephone system for the use of

General Practitioners in rural areas and would

report to the Board in due course when the

information required was available.

(3) Welfare Homes Building Programme:

Tenders for the conversion and extension of the

former T.B. Hospital, Belmullet, into a Welfare

Home and Practice Premises had been advertised,

closing date being 12th July, 1973.

(4) Report of Working Party on Psychiatric Nursing Services of Health Boards:

Copies of this report which had been published,

were circulated to each Member at the Meeting.

The Chief Executive Officer stressed its

importance and the necessity to study its

implications for the psychiatric services.

It was proposed by Senator M. D. Lyons seconded

by Mr. M. J. Egan and resolved:-

"That we hereby request the Minister for Health to

sanction without delay, the salary recommended for

the position of Medical Officer, District Hospital,

Ballina, in report of Chief Executive Officer

dated 30th January, 1973, and adopted by the Board

17 - 7 -

at meeting of 5th February, 1973, and to refer the

vacancy to Local Appointments' Commission for

advertising forthwith."

Mr. Erskine H. On the proposal of Councillor J. R. Lenehan seconded Childers, T.D. by Mr. M. J. Egan, the Board congratulated President-Elect; Mr. Erskine H. Childers, T.D., on his election to

the Presidency of Ireland particular tribute being

paid to his contribution to the development of the

health services as former Minister for Health.

Dr. Donal O'Donoghue, On the proposal of Dr. M. J. McLoughlin seconded by - Mr. P. D. Joyce, the sympathy of the Board was extended Vote of Sympathy: to Dr. Donal O'Donoghue, B.D.S., on the recent death

of his father.

Chief Executive Officer, on behalf of the Staff and

on his own behalf joined in the expression of sympathy.

This concluded the business of the Meeting.

r* Signed: E. Hannan, Chief Executive Officer.

Date: 12th June, 1973.

Confirmed and adopted at Meeting of Western Health

Board held on 2nd July, 1973.

Signed . L&ttlilJ U'l*^L Chairman. BORD SLAINTE AN IARTHAIR WESTERN HEALTH BOARD

teport of Sub-Committee established at Board Meeting of Monday, jth March, 1973, to examine and report on the future of the Maternity Department at Calvary Hospital.

Preliminary

|l.l. The following Sub-Committee was established by this Board at meeting of 5th March, 1973, to examine and report on the future of the Maternity Department at Calvary Hospital, Galway:-

Mr. M. J. Egan, Dr. M. 'J. Dyar, Dr. M. J. Mylotte, Dr. J. J. Tobin, Dr. M. J. McLoughlin, B.D.S., Councillor M. Ryan.

1.2. The Sub-Committee at first meeting held on Tuesday, 27th March, 1973, appointed Mr. M. J. Egan, Chairman.

1.3. The Sub-Committee met on four occasions and was assisted during its deliberations by Professor E. 0' Dwyer, Consultant Obstetrician/Gynaecologist, Galway Regional Hospital.

Recommendations.

•2.1. That a General Practitioner Maternity Unit of not more than I twelve (12) beds be established at Calvary Hospital, Galway.

2.2.' That General Practitioners residing within a ten mile radius of Calvary Hospital with the right interests, training and experience of Maternity work would be eligible to participate t in the scheme.

2.3. That only cases in which no abnormality is expected shall be admitted to the unit, all such cases to be screened at Consultant clinics held at Galway Regional Hospital and/or Calvary Hospital.

2-4. That Consultant cover shal^,=,11l hbpe provideprovxu d to deal with any emergencies.

i4--,r,+- obstetric at (a) The three Consultant Obstei-j-x Galway Regiona• li Hospitaun^nita-l and the two Co^^^^^^^^^^n lit ^

/2 - 2 -

Obstetrician/Gynaecologists at Calvary Hospital shall Provide cover on a rota basis with each Consultant covering one night in five and every fifth weekend. The cover by the three consultants at Galway Regional Hospital should, where possible, coincide with the on- call duty at Galway Regional Hospital.

(b) The two Consultant Paediatricians at Galway Regional Hospital shall provide emergency cover for cases which cannot be transferred to Galway Regional Hospital.

(c) A Consultant Anaesthetist will be summoned by the appropriate consultant as required.

2.5. That the participating general practitioners shall provide continuous round the clock care for the unit under an approved rota scheme.

2.6. That the authorities of Calvary Hospital shall arrange for the establishment of a Management Committee to regulate admissions and to supervise the operation of the Unit, including the selection of the participating doctors. This Committee might consist of:-

Matron and one other member of congregation ) Calvary Hospital Two Medical Staff )

Galway County Medical Officer, From Staff of ) One Consultant Obstetrician/Gynaecologist ) Western Health One Consultant Paediatrician ) Board. One Consultant Anaesthetist

The General Practitioner representative on Galway/Merlin Park Regional Hospitals Executive Committee.

This Committee shall select a Chairman from among its members.

2.7, Th at the working of the unit be reviewed after one year.

£orm of Agreement

3.1. •*-xs , iDHtxnci General Practiti< A form of agreement with pdrticiparii-y w« shall be drawn up bv.y th4-T,e« autnorxtxeauthorities* of Calvary Hospital, and shall include the following:-

(a) The beds xn the unit snaxj of a participatin• • .4Hg™ aocvudocvotr and flexibility shall operate. " /3 - 3 -

(b) The authorities of Calvary Hospital shall maintian a list of participating doctors.

(c) A General Practitioner wishing to participate in the unit shall make a formal application to the authorities of Calvary Hospital to have his/her name entered on the list.

(d) A prior condition for the acceptance and continuation on the list is membership of a recognised medical protection society or adequate insurance against claims for / negligence. / (e) A participating doctor may withdraw from the scheme by giving six weeks prior notice to the authorities of Calvary Hospital.

(f) Each participating General practitioner must accept full responsibility for the medical needs of his/her patients, deal personally or through his deputy with all emergencies and make arrangements for Consultant services when he considers it necessary.

(g) A Consultant Obstetric service shall operate as follows at the request of the general practitioner:-

(1) Reference of patients to Consultants at Calvary Hospital, (2) Reference of patients to Obstetric clinics at other hospitals, and (3) Visits of a Consultant Obstetrician for the treatment of emergencies and other problems at the request of the patient's Medical Attendant.

(h) The authorities of Calvary Hospital shall notify forthwith the general practitioner when his/her patient is admitted. (i) The reaister of cases maintained in the Maternity Department, Calvary Hospital shall include the name • of the doctor responsible for the care of the patient.

(j) Calvary Hospital shall supply all nursing and other ancilliary services.

(k) The general practitioner shall personally complete a hospital sheet ana- cas«-oee. notenntpss for each patient. The , j ^--Mc: of blood groups and obstetrxc notes must include de-

A - 4 -

history.

(1) A Consultant Obstetrician/Gynaecologist in the joint discharge of his clinical responsibilities with his general practitioner colleagues must be granted facilities to inspect and assess the operation of the scheme and facilities to examine booked patients during pregnancy.

(m) All doctors shall ensure a quick bed turnover. The average length of stay in the Unit should be in line with the average for other maternity beds in the hospital,

(n) Any disputes regarding the operation of the Unit should be referred to the Management Committee.

(o) The authorities of Calvary Hospital will have the right to withdraw the facilities granted to a general practitioner under the scheme subject to a recommendation from the Management Committee.

(p) The right of any participating general practitioner to charge a reasonable fee to private patients to be recognised.

Finance.

4.1, It is essential that the capitation rate payable for eligible patients be increased to a realistic level and the Minister for Health in determining this rate should be asked to take into account that this proposal be treated as a pilot scheme for general practitioner maternity units in this country.

Signed: M. J. Egan, Chairman.

M. J. Dyar

M. J. Mylot

j. i bin

(hlin, b.D.S,

25th June, 197 3. f* ' • B0RD SLAINTE AN IARTHAIR. .'•'•. WESTERN HEALTH BOARD.

Minutes of Meeting of Community Care Standing Committee held on , 16th May,. 1973, at Merlin Park Regional Hospital. •

•RESENT: Dr. J. Tobin, Chairman; Mr. M. McLoughlin, Mr. J. P; C^Donnell, Councillor Morley; Mr. J. Costello; Mr. M. Mannion.

In Attendance: Mr. P. McDaid, Programme Manager, Community Care, and

• Mr. J. O'Leary.

Minutes. Minutes of Monthly meeting held on 4th April 1973, were

confirmed on the proposition of Dr. M. McLoughlin,

seconded by Councillor Morley.

Report Rate, The Committee considered a report on the General Medical General Medical Services. This was discussed in detail and was adopted Services. on the proposition of Mr. O'Donnell, seconded by

Senator Mannion. It was agreed that if possible the

Board for its next meeting should visit some doctors''

residences, subject to the consent of the doctors

concerned, and would consider a further report concerning

the question of sale of residences.

Social The Committee indicated that they considered the Workers. employment of these workers vital to the development

of voluntary effort.

Locum Report on precise position was to be made for the Arrangement .for General next meeting. Practitioners

Radio It was noted that the Board wished this matter examined Telephone. and it was agreed that details of Cost and feasibility

should be obtained.

Signed: Lb. ^ P. McDaid, »t/^/ Programme Manager, ^-^"* Community Care. /2... :.*.

Datei lfrth J»ne, 1973.

*• • Confireod and adopted at Meeting of Community Care

Standing Coamittee on Tuesday 26th June, 1973.

Signed: Chairman.

1

.

f BORD SLAINTE AN IARTHAIR

(WESTERN HEALTH BOARD)

REPORT TO COMMUNITY CARE STANDING COMMITTEE

GENERAL MEDICAL SERVICES

INTRODUCTORY

'The General Medical Services Scheme has been in operation in this Board's region since 1st October, 1972 and it is, considered opportune to commence an appraisal of its functioning. It is probably too soon to attempt a definitive appraisal, partly because the Scheme's inception is too recent, partly because adequate information is not yet available. Meanwhile however many important decisions require to be taken affecting the Scheme in the region, and it is desirable that those decisions be as well informed as possible.

Though it hardly needs clarification it should be stressed that the proposed appraisal relates only to the functioning of the Scheme within the region and to the decisions which this Board has to take in relation to that functioning.

Since any worthwhile study of the Scheme must concern itself also with the provision and organisation of ancillary services and wxth the relationship between the general practitioners service and the public health and hospital services it will be clear that no sxngle report to be considered at a single meeting could do justice to «« subject. The present report is therefore presented as a prelxmxnary one incorporating both general background information and some detax1. in elation to this region. ifi. Hoped to agree wx the ommx on the broad basis of the approach to the ^"Y^^^" outlined. Further reports to the Committee wx 1 devel p approach in the direction of a coherent polxcy at Board level wxthxn the context of national guidelines.

ji „ „rv svstem in the following principal The Scheme replaced the dxspensarc y system ways:-

(a) a choice of doctor, where practicable;

r^ \ + +h«t there be no discrimination in surgery (b) a requirement that tnere u „„*;.,»'-• \uj u icH i:„;hle and prxvate patxen..-, arrangements between elxgxble P ,. • tw retail pharmacists on prescrxptxon, (c) the supply of medxexnes by retaxl p where possible. /2 AVATI ABILITY OF DOCTORS

In much of the Region* no choice of.doctor exists* - In many places ...... the single doctor available is overworked, in terms of numbers of patients and distances to be travelled, is working in considerable isolation from colleagues and has difficulty in arranging adequate locum relief. This not only creates hardship for the doctor but inevitably reduces the standard of care available for patients. Even.in those places where a choice of doctor exists there has not, with some few exceptions been any significant move towards group practice, partnerships, or shared rota arrangements. Such arrangements enable a better service to be given to patients and make re-organised service more attractive to doctors interested in general practice. There are various reasons for the slowness of moves in this direction but it should be an objective of the Board to encourage cooperative developments between doctors.

Schedules are attached as follows:-

Lists of Doctors by sub-divisions of Region, their APPENDIX I - residences and other centres of practice and showing the nearest participating doctor in adjoining areas.

The relationship of doctors to population and area APPENDIX II - in each sub-division.

The number of doctors with patient lists within . APPENDIX III - certain ranges of numbers.

•+-«n in each district should be examined 8ltl It is proposed that the P° ^ b

should be erected, one xn North Wes ^^ ^ ^ ^ of

These extra positions ore )us ^ ^ ^^ of |

2,000 potients for "V"' *!*^' tiatI<„. should tok. ploc. so thot it is further recommended tnor » districts of Bclmullet, i \A +hen cover tne ««" the four doctors who would xn . ^ located as a group between Kn cknal Wer U Bangor-Erris and ° ° f^° that there is a District Hospital c Belmullet and Bangor. B lBullet should facilitate this and will also be a Welfare Home in ^^ ^ recently been proposal. A similar arrangement ^^ ^^ where iho two existing doctors were augmented by a third and a measure of cross-cover was agreed. *

A Group Practice is operating in Mervue, Galway City. A proposal for group practice premises has been agreed for Ballina and. a proposal for Ballinasloe is with the Department of Health. The possibilities in other centres should be considered by the Committee.

COMMON SURGERY. ARRANGEMENTS \ *

The provision that there be no discrimination in'surgery arrangements between eligible and private patients is not yet anything like fully operative. This arises in a number of ways. In some parts of the region it is necessary to retain former dispensaries in use, where the dispensaries, are located some distance from the doctors' residences, In those cases it is necessary to improve the standard of accommodation to the standard required of a doctor providing premises of his own. Where a dispensary is attached to a residence the same necessity arises, except that if there is a surgery also available in the residence then any improvement should be to one or the other, on the basis that only one will be used for all patients. In both these cases, and in the case of health centres or group practice premises where more than one doctor is practising, it may be necessary and is certainly desirable to work towards an appointment system. In the case of health centres or group practice premises it would also seem desirable to aim at 5-day week functioning of the premises, with at least one doctor on duty at all times.

The next report to the Committee will set out details of the location and condition of the different premises in question throughout the region and it is proposed that discussions would then take place with the doctors concerned to determine what help the Board can give in achieving the original objective.

SALE OF RESIDENCES

Provision exists whereby the Board may continue to rent a residence to a doctor or, at its discretion, sell to a participating doctor who ... .. doctors have expressed a desire is occupying it at the time . Man•'"««y/ to purchase the houses they ore living in ond it 1. understood thot there

/* . are others who endeavoured to purchase some years ago and who may still-be interested. The condition of these houses varies greatly but most are in need of a good deal of urgent work and subsequent maintenance. It would seem sensible from the Board's point of view and fair to the doctors concerned that a decision one way or the other should be .taken as soon as possible. Even if decision*to sell in particular cases are made against a general background of willingness to do so it seems clear from a preliminary consideration of the matter that there will be cases where it would be extremely upwise of the Board to sell. In particular it'would be foolish to dispose of a residence in any district where the availability of a residence might be a significant factor in ability to attract a doctor. However decisions can only be taken after consideration of the circum­ stances in each particular case.

I recommend that the position in each case be examined to determine what the attitude to sale should be. Following this examination specific recommendations in particular cases will be put before the Committee, prior to consideration by the Board.

8. ANCILLARY SERVICES

The provision of adequate ancillary services is of critical importance in the organisation of an effective and comprehensive system of primary medical care. While the Board might not have direct responsibility for the provision or funding of all of them it must have a great > interest in rendering all possible assistance in their provision. These services include district nursing, use of practice nurses, secretarial help, social work (including psychiatric), home helps, voluntary organisations, access to diagnostic facilities, availability of such services as physiotherapy and chiropody, communication facilities such as radio-telephone. It is proposed to submit further reports to the Committee concerning the improvement of ancillary services.

•

9. RELATIONSHIP TO OTHER SERVICES *

The relationship of the general practitioner service with the public health service and with the hospital service will also be the subject of a further-report, as will the position concerning the .upply of medicines. /5 f IMMUNISATION SERVICE

A particular and potentially very serious problem exists at present concerning immunisation and vaccination against poliomyelitis, diphtheria, tuberculosis and rubella. • Prior to 1st October, 1972 these procedures were provided through the public health service and the district medical off icers. They were not however included in the items of service covered by the reorganised general medical service and accordingly participating doctors were not obliged to perform them. The inadequate numbers of public health medical staff (which will be the subject of a special report soon) is such that the child and school health service is not being provided to the specified level and the staff cannot provide the required immunisation service. Negotiations have been taking place between the Department of Health and the medical organisations concerning the basis on which these procedures might be provided but these negotiations have not yet been concluded. The Chief Medical Officers have been asked to arrange with general practitioners for the provision of the service on the basis that they will in due course be paid in accordance with whatever agreement is reached nationally. One of the medical organisations has however written recently to the effect that its members may be asked to withdraw their services if national agreement is not soon reached.

No specific recommendation is being made in this matter at the moment but the matter will be kept under review.

COST

The cost of the Choice of Doctor and Choice of Pharmacist Schemes for year 1973/74 was estimated at approximately £1T million. The latest indications are that this figure will be somewhat exceeded but it is perhaps premature to make firm forecasts. Two factors are of significance. Firstly, the visiting rates on which original costings were made appear to be slightly understated for this region, though it should also be stated that the region has one of the lowest average visitin... g rates i•n thJ.UeQ i-nnn+rcountryv . Secondly^<-«i /, the cost of medicines is running at a higher level than was expected.

„ i: , e aiven at the Board's monthly At present regular reports on costingnc nrts arare given meetings and these will be continued. It is hoped also to refine the identification of the elements contributing to the overall cost.

APPRAISAL PROCEDURE., +u;* i«; merely the commencement of an As was stated at the outs. ^ * ^ £,„, t0 cost nore mone,. appraisal. The re-organised Schen,e g The justification for this increased cost must lie in the provision of a higher quality service. This service should result in a healthier ' community with the consequent advantages in human, social and economic terms which this implies and there should also be consequent better utilisation of hospital services, if not direct savings.

It is proposed to discuss with the Committee the formulation of indicators which will assist in the ongoing appraisal of the Scheme.

The development of an adequate information base will be a slow process but it is en indispensable prerequisite to decision making. It is suggested that this base, with the other reports referred ta, and any others .which the Committee may seek, will assist in the determination of Board policy.

•3. SPECIFIC RECOMMENDATIONS

(i) ' Create two extra posts in the general medical service, one in North West Mayo and one in Mid-Galway.

(ii) Examine the matter of sale of dispensary residences, taking into account the merits in each individual case.

14. MATTERS FOR FURTHER REPORTS

(i) Location, condition and future use of health premises.

^ (ii) Recommendations as to sale of dispensary residences.

(iii) Ancillary services. (iv) Relationship of general practitioner seivice with

(a) public health service; (b) hospital service.

15. Because of the relevance to further reports of some of the material presented with this report, the material is being presented to the Committee on a file basis, so that further material may be conveniently associated. i

ENCLOSURES

\ Lists of Doctors by sub-divisions of Region, their APPENDIX I residences and other centres of practice and showing the nearest participating doctor in ad jo^ng-area^ . 1 I

APPENDIX II The relationship of doctors to population and area in each sub-division.

APPENDIX III The nuaber of doctors with patient lists within certain ronges of numbers.

Signed P. McDaid. Programme Manager, Community Care. i

Date; 7th May, 1973.

•: BORD SLAINTE AN TARTHATP APPENDIX I

Nearest Participatino Residence Name Centres of Practice Doctor in adjoining area. •

[AY CITY &*•.,'• JIRONS j

ce, Noel E. / Rahoon Rahoon (2)

Lins, Desmond Renmore Rd. Renmore .Road, . Oranmore (2)

^ay-McGee Eithne Glenard Cres. Glenard Crescent, Oranmore (2) Mervue Clinic

ney-Casserly, E.M. Renmore Park Renmore Park Oranmore (2)

% The Crescent The Crescent hn, Gabriel P. Oranmore (2)

kin, John College Rd. College Road, Oranmore (2) Mervue Clinic.

tin, Patk. J. Eyre Square Eyre Square Oranmore (2)

reevy, C.P. University University Oranmore (2) Park Park

leirn, Donal P. The Crescent The Crescent, Oranmore (2) County Clinic.

[yme, Patk. E. Maunsells Rd. Maunsells Rd., Oranmore (2) Mervue Clinic.

•allaghan, Maureen Newcastle Newcastle, Oranmore (2) County Clinic.

rlaherty, Ml. J. Sea Road Sea Road, Oranmore (2) County Clinic.

&y, Evelyn M. St. Mary's Rd. St. Mary's Road, Oranmore (2) County Clinic i*n# John P. Mountpelier .Mountpelier Tee. Oranmore (2) Tee.

• . BORD SLAINTE AN lARTHAIR APPENDIX I:

Nearest Participating lame Residence Centres of Practice Doctor in adjoining area.

• gALWAY V.'EST .

ley, John F. Bealadangan, , (i ) • ' Ballinakill.

ire, Agnes Carna Carna, Roundstone (l)

jr, Michael J. Clifden, Inishboffin (l)

ivan, E. J. Cornamona, Cong (1) Kilmilkin, Leenane.

• Ed. J. , Aran •Kilronan Lettermore (l)

in, Albert M. Letterfrack Letterfrack, Tully Clifden (1)

Bealadangan (l) iole, John A. Lettermore Lettermore, , Carraroe

Galway (14) lly, Eamon Moycullen

Moycullen (l) iter, Patk. R. Oughterard 1 f Roundstone, Recess Clifden (l) :aghty, Patk, J. Roundstone

Moycullen (l) •ningham, Connell Spiddal, Tully

•

• 1 BORD SLAIUTE AN.IARTHATP • APPENDIX!

Nearest Participating Name • Residence Centres of Practice Doctor in adjoining area

LWAY-MID,

lmain, Tadgh Abbeyknockrnoy Abbeyknockrnoy, (l)

n, Roibeard Athenry, Attymon, Turloughmore (l) •

Sello, Michael Headford, Corrundulla Cong (1)

*} Thos. Edward Jranmore Oranmore Galway (14)

frinor, Seaghan Oranmore Oranmore Galway (14) [ Bea, Thomas Turloughmore Turloughmore, Corrandulla Abbeyknockrr.oy (l)

%

' May 1973 pL/BB. APPENDIX I BORD Sl-ATNTE AN IARTHAIR

Nearest Participating Jtame . Residence Centres of Practice Doctor in adjoining area.

EAIVJAY SOUTH-EAST

/• •

. 7 Eyrecourt, uran, James / Laurencetown (1

:e, Mona Gort, ,Peterswell

Se, Patk. F. Gort Gort Kinvara

ii, James Kiltormer Kiltormer, Aughrim Laurencetown

*, Peter J.K. Kinvara Kinvara Gort oney, Thos. M. Laurencetown Laurencetown, Esker. Eyrecourt r, Martin J. Loughrea, Kilchreest Athenry

Oney, Barth. Loughrea Loughrea Athenry bnnor, Owen Loughrea Loughrea Athenry

•ell, James S. Loughrea Loughrea, Bullaun, Athenry Derrybrien.

e-Royston, T. Portumna Portumna Eyrecourt

:ant Portumna Portumna, Tynagh Eyrecourt

•Shton, Patk. F. Portumna Portumna, Woodford, Eyrecourt Gorteemy

May 1973. JO'L/BB APPEMCtX I BORD SLAINTE AN LARTHAIR

isiearest PaTEJclpatiTft Name Residence Centres of Practice Doctor in adjoining area •

•

UWAY WORTH-EAST - ^_— . • Joseph Ballygar, Dysart Athleague (l)

, Madeleine, K. Ballygar Ballygar, Dysart Athleague (1)

Balllnasloe ledy, Michael E. Ballinasloe, Ballydangan Kiltormer (l)

r jey, J. Ballinasloe Ballinasloe, Aughrim Kiltormer (l) *

gan, J. Dunmore Milltown (1)

aghty, Patk. J. Glenamaddy Williamstown (l)

Kg/ Kilconnell, Ballinasloe (2)

tarry, Nora Milltown Milltown, Dunmore (l)

•lotte, Michael Mount Bellew; Caltra Ballygar (2) Kilconnell, . k w— — Mountbellew Mountbellew Ballygar (2) •eirne, Redmond M.J. ^

'ningham, Thos. J. Tuam Abbeyknockmoy (l) tzgerald, Patrick Tuam Tuam Abbeyknockmoy (l)

r°n, John C. Tuam Tuam &bbeyknockmoy (l) nny, Peter P. Tuam Tuam \bbeyknockmoy (l)

• her, Daniel Tuam Tuam Abbeyknockmoy (l) I

Ldron, A. Tuam Tuam i Abbeyknockmoy (l) I cant Williamstown. Williamstown i Jlenamaddy (])

- PCRD SLATNTE A?-: IARTK*IR • " APPENDIX I

Nearest Participating Residence Maine Centres of Practice Doctor in adjoining area.

. * LAYO NORTH-WEST .

• /; ,. Edward M. /• •Achil- 1 . . Keel, Ballycroy, (2) J ,

Ice, A. de V. (Jr) , Ballina Ballina Crossmilina (2) |

ley, John E.. Ballina Ballina (2)

gne, A. Ballina Ballina Crossmolina (2)

rien, John Ballycastle Ballycastle, (1) ! .

ldrew, P. Bangor-Erris Bangor-Erris, Belmullet (D * Geesala

Ly, Thos. J. Belmullet Belmullet Bangor-Erris (1)

Le, Ed. J. Crossmolina Crossmolina (2)

tus, M. J. Crossmolina Crossmolina Lahardane (2)

Ballina garry, Jos. F. Killala Killala (4)

Bangor-Erris ant Knocknalower , Bawhane 0)

Crossmolina (2) "tus, Angela Lahardane Lahardane, Beltra, Ross

Crossmolina (2) - "tus, John V. Lahardane Lahardane

Keel bes, James Mulranny Mulranny, Clare Island 0) Inishturk

,ne Keel en, Patk. J. Mulranny Mulranny, Ballycroy, (1) Clare Island, Inishtur • Newport, Rosturk Westport (4); t fea, Mgt. M. Newport

1 1

Ma ^£3 •iM>{|^ APPENDIX I BOSD SLAIrlTF At! IARTHATR

Nearest Participating; lame Residence Centres of Practice Doctor in adjoining area. !

iVO SOUTH - WEST

jnS/ James J. Ballinrobe, (l)

nan, e* Ballinrobe Ballinrobe, Hollymount (1.)

irby, John Ballinrobe Ballinrobe, Cloribur, Hollymount (l) Headford.

an, Tadhg Cong Cong, Ballinrobe (3)

Ifield, Michael JJ. Hollymount Hollymount, Ballinrobe (3)

»gh, Columb Louisburgh Louisburgh Westport (4)

wne, Francis J. Tourmakeady Cappaghduff, Finney Westport ' (4)

(rell, Hubert Westport Westport Newport (D

Newport (D •ly/ De smond Westport Westport

Newport jii/ John Joseph Westport Westport, Aughacower, (D

Newport (1) fan, John E. Westport Westport BOPvD SLAINTE AN" IARfrfMR APPENDIX •!,

Nearest Participatinc Name Residence Centres of Practice Doctor in uc: joining area. jAYQ MID-EAST lire, Willibm J, Balla Balla, Ballyvary (l) jron, William R, Ballindine Ballindine Claremorris (2) iney, Alan D, Ballyhaunis, Loughglynn, Lisacul. Willicnstown (l) je, Thomas B. Ballyhaunis Ballyhaunis Williamstowri (l) dron, Eamonn A, Ballyhaunis Ballyhaunis, Ballinlough, Cloonfad Williamstown (l)

Evilly, Myles Castlebar Castlebar Balla (1)

-ire, Sean Castlebar Castlebar, Killawala Balla (1)

Bn, Bert Castlebar Castlebar Balla (1) in, Richard Castlebar Castlebar Balla (1)

Charlestown >y, Francis Charlestown (3)

Charlestown lien, Martin J. Charlestown Swinford (3)

Claremorris ie, Noreen Claremorris Ballindine (1)

Claremorris Claremorris Ballindine (1)

•es, John J. Foxford, Castlebar Straide (0

Uly, Patrick J. Kilkelly, , Swinford (3) Tooreen tooghue, Patk. J. Kiltimagh Kiltimagh, Swinford (3)

Foxford tody Heyns, Bgt.A. Straide Straide, Foxford (D

Charlestown (2) toy, Philip F. Swinford Swinford

Charlestown (2) >u9hlin, Diarmuid Swinford Swinford Charlcitown T^T Swinford ~5wintorcT~

J Aclare, Bcnada, Tubbercurry (T) 3han, Lou le Aclare, Co. Sligo Curry.

Tubbercurry Charlestown (2) 1nery, Sean Tubbercurry, Co. Sligo APPENDIX I BORD SLAINTE AW IARTKAIR.

Nearest Participqtir Name Residence Centres of Practice Doctor .in adjoining area.

ROSCOMMON - NORTH jgerald, A, Ballaghaderreen Ballaghaderreen Frenchpark (l)

ton, • L.M; Boyle Boyle, Cootehall Carrick-on- Shannon (2) i, D. G. Boyle Boyle Carrick-on- Shannon (2) fallen, D.J. Boyle Boyle, Ballinameen Carrick-on- Shannon (2)

Ly, Mary W. Castlerea Castlerea Williamstown (l)

Jhy, F. T. Cqstlerea Castlerea Williamstown (l) ant Castlerea Castlerea, Carrabane Williamstown (l)

Lery, A. Elphin Elphin Strokestown (2) jnan, M.J. Frenchpark Frenchpark Ballaghaderreen (l)

Carrick-on- Jons , Hugh Keadue Keadue, Ballyfarnon, (2) Arigna. Shannon •essy, Noel St.J. Rooskey Rooskey, Cloonmore Carrick-on- Shannon (2)

•on, M. Strokestown Strokestown Elphin (D

*r, W. Strokestown Strokestown Elphin (D

», K.P. Carrick-on- Carrick-on-Shannon Boyle (2) Shannon.

"y, w.j, Carrick-on- Carrick-on-Shannon, Boyle (2). Shannon Cootehall, Kilmore, Killumod. Lanesboro (2) rry, patk, Longford Longford APPENDIX I BORD SLAINTE AM TARTHATR

Nearest Participatinc Name. Residence Centres of Practice Doctor in adjoining area.

• *

JOSCOMMON - SOUTH

ane, Michael, Athleague, Athleague, Castlecoote Ballygar (2)

ay, J.' A. Knoc'kcroghery Knockcroghery Roscommon - (3)

an, D. Roscommon .Roscommon Athleague (l)

.jrtm, E. Roscommon Roscommon, Ballyleague, Athleague (l) Derrane.

>rman, T. J. Roscommon Roscommon Athleague (l)

:patrick, John Athlone Athlone, Glasson Ballinasloe (2)

Long, N. Athlone Athlone Ballinasloe (2) "

ie, J. J. Athlone Athlone, Kiltoom Ballinasloe (2) k ron, B. J. Athlone Athlone Ballinasloe (2)

Ballinasloe (2) amara, J.J. . Athlone Athlone

Ballinasloe (2) anion, R. K. Athlone Athlone

• Ballinasloe (2) eara, John F. Athlone Athlone, fill, Ursula Athlone Athlone, Brideswell, Ballinasloe (2) Ballyforan. e, Justice H. . Athlone Athlone Ballinasloe (2)

Roscommon (3) don, F. G. Lanesboro Lanesboro

Roscommon (3) onoghue, Patk. Lanesboro Lanesboro ^^^ APPENDIX II BORD SLALTTE AN IARTHAIR

General Medical Service

Relationship of Doctors to Population and Area

Partic­ Persons Doctors Sub-Region" Population Area ipating per per 100 (Acres) Doctors Doctor. square miles

ay City & Environs 31,705 21,403 14 2,265 41.86

ay - West 25,465 467,176 11 2,315 1.51

- Mid 21,402 215,031 6 3,567 1.79

. - South-East 28,873 385,895 13 2,210 2.16

- North-East 41,778 378,165 17 2,458 2.88

Sub-Total: 149,223 1,467,670 61 2,446 2.66

- North-West 41,048 656,744 17 2,415 1.65

- South-West 23,210 307,795 11 2,110 2.29

- Mid-East 45,267 359,401 22 2,058 3.92

Sub-Total: 109,525 1,323,940 50 2,190 2.42

fcommon - North 33,250 376,410 16 2,078 2.72 - 1,267 4.41 - South 20,269 232,130 16

3.37 Sub-Total: 53,519 608,540 32 1,672

2,215 2.65 TOTAL: 312,267 3,400,150 141

'•L MAY 1973 GENERAL MEDICAL SERVICE - Relatianship pf Dactprs ta Eligible Patients

Participating Urs. classified acccrding ta number pf patients an lis

1 Total 101 - 401 1 701 - 1001 - 1501 - 2001 - over SUB-REGION 1* °-400 700 1000 1500 2000 2500 2500 100

GALWAY-CITY & ENVIRONS 14 2 - 7 1 2 2 - -

GALWAY WEST 11 - - 2 2 4 1 2

GALWAY MID 6 - 1 - 1 - 3 - 1

•M GALWAY SOUTH-EAST 13 - - • 8 3 1 1 -

GALWAY NORTH-EAST 17 1 3 1 4 2 5 1 - MAYO NORTH-WEST 17 *3 1 3 1 3 1 2 3

KAYO SOUTH-WEST 11 - 2 3 2 1 2 1 - 1 MAYO MID-EAST 22 3 1 2 4 4 2 5 1

1 ROSCOMMON NORTH 16 1 3 3 5 2 . 2 - -

1 ROSCOMMON SOUTH 16 3 6 3 4 - - - -

TOTAL 143 ^13 17 32 27 19 19 11 5

* Th Ls numbe r incli des pn< i vacant post an i an ass istant doctc

JO'L/BB.

i • "x. ; __