A Cork medical centre is the face of modern medicine as envisaged by the HSE in its primary care strategy, writes MICHELLE McDONAGH
IT’S THE future of primary care in Ireland as envisaged 10 years ago when the primary care strategy was launched. In a modern, bright purpose-built facility, patients can visit their GP, get their eyes tested, have a physio session, get their prescription filled and a whole lot more, all under the one roof.
At the Mallow Primary Healthcare Centre in north Co Cork, 17 local GPs and eight nurses work in three separate practices – The Medical Centre, The Red House Family Practice and the Cork Road Clinic.
Each of the GP practices, which have relocated to the specially designed, state-of-the-art 6,500sq m building one and a half kilometres from Mallow from cramped facilities in the town, remain independent with their own separate clinics and reception/waiting areas.
A fourth facility, aptly called The 4th Practice, is home to a range of allied services including an ultrasound clinic, a sports injury consultant, a physiotherapist, a psoriasis clinic, a personal and business coach, and a counselling psychologist.
On the ground floor, John Mulcahy runs the spacious, well-designed pharmacy opposite Jill Farrell Opticians, while fellow locals, Matt and Patricia Casey, run the Pain Clinic where therapies such as reflexology, cranio-sacral therapy and hot stone massage are on offer.
The three-storey €28 million centre is also home to an array of HSE services including medical card administration, home help, public health nursing, social work, speech and language therapy and occupational therapy.
The SouthDoc out-of-hours GP service is also located in the building and is used as office space by the HSE during the day.
The Mallow centre boasts the largest range of primary care, health and social services currently under one roof in Ireland and is a shining example of the modern face of primary care as envisaged by the HSE in its primary care strategy 2001.
The plan was for the development of 200 primary care centres as the central focus of the delivery of health and personal social services in Ireland. To date, only 32 centres have been completed and are in operation.
The Mallow building is owned equally by 10 GPs and leased by the HSE. A total of 23,000 patients are registered with the three practices, and of the 900-1,000 people who walk through the front door each day, 85 per cent are headed for one of the GPs.
The lead GPs from each practice, Dr Tony Heffernan, Dr Harry Casey and Dr Dave Malony, have always had a strong interest in research and auditing and are pleased that they now have the infrastructure, IT and, most importantly, the patient database to do this.
“The ethos of auditing means looking at what you are doing, seeing if something can be improved upon, improving it and auditing again. This is a very important concept in any business, especially healthcare,” says Heffernan.
“We run patient expert groups, similar to the UK concept of patient participation groups, to listen to how our patients perceive their needs. It’s so important that the patients are involved in helping to develop the service they need.”
Uniquely for the primary career setting, the centre employs a full-time researcher from UCC, anthropologist Cormac Sheehan, who is funded by the HSE. There are a number of research projects going on at the Mallow centre, all with the aim of improving services for patients at the primary care level.
One early intervention project aims to prevent people over the age of 70 from going into hospital for unplanned or emergency admissions, which cost 30-40 per cent more than planned admissions.
Research has shown that unplanned admissions result in unnecessary tests, increased waiting time, inappropriate waiting on trolleys and increased stress and strain for elderly patients, says Sheehan.
“We are using a seven-point questionnaire to identify patients over 70 who are at high risk of unplanned admission and once this risk is identified, an appropriate intervention can be put in place depending on the individual patient’s needs,” he says.
“This may mean simply referring a patient back to their GP, or making an appointment for them to see a physio or occupational therapist if they have eating difficulties. We may need to send out a public health nurse or home help or an OT may need to go to assess the patient’s home.”
Elderly patients who are sent home after unplanned admissions with no support system in place are often readmitted fairly quickly, says Casey.
The Mallow project involves an in-reach programme with the hospitals to get the patient back home again as quickly as possible, supported by their primary care intervention team.
Another interdisciplinary project involves the GPs, dietitians, psychologists and health-promotion teams working with families with an increased level of diabetes and obesity to try to break the trend of type 2 diabetes – at no cost to the families.
This six-month project involves monthly family meetings where advice is given on healthy shopping and eating, and family members have their weight and body mass index monitored.
Casey says: “You can almost predict the patients in general practice who will develop diabetes – those with a strong family history, bad eating habits, lack of exercise – and it’s happening younger and younger.
“Sometimes, it’s very hard to prevent unless you change the eating habits and lifestyle of the entire family. This project is a new approach to doing that and, if successful, it could be replicated elsewhere.”
