Doctors have warned the Government against seeking to tackle the shortage of GPs by establishing alternative nurse-led clinics in the community.
The Irish Medical Organisation (IMO) said there was currently insufficient evidence to support nurse-led care in the community. Instead, it urged the Government to introduce a new contract for GPs with terms and conditions that were sufficiently attractive to encourage doctors to seek a career in the Irish health service.
In a submission to the Government’s new review of bed capacity in the health service, the IMO said: “Arguments in favour of nurse-led services centre around perceived quality of care and patient satisfaction and propose a solution to the imminent shortage of GPs, however, there is no evidence to suggest that patient outcomes are improved or that care is more cost effective.
“A recent systematic review of evidence relating to autonomous advanced nurse practitioners found no evidence that health status, quality of life, hospitalisations or mortality are improved and that there was no evidence to justify the position that independent advanced nurse practitioners provide the same quality of care as medical doctors.
Evaluated
"The unpublished evidence review carried out on behalf of the Department of Health found no single overarching model of nursing and midwifery practice in the community that had been scientifically evaluated had emerged.
“The review also found that there was insufficient evidence to inform the cost effectiveness of integrated models of nurse led care in the community and that further research was needed to underpin the development of future services. Despite this, the Department of Health is proposing a vague model of nurse-led community health services that, rather than complementing GP care, will offer an alternative model of care that undermines continuity of care in general practice and risks further fragmentation and duplication of care.”
The doctors’ trade union also suggested State incentives for the development of GP infrastructure such as premises and medical and diagnostic equipment.
It called for allowances to be provided for the employment of practice staff such as doctors, nurses and support personnel.
Demand
It also said expansion of free GP care should only be introduced “on a phased basis taking into account income and medical need” and in circumstances that ensured there was sufficient capacity to cope with increased demand.
It urged the Government to increase urgently acute bed capacity in hospitals to allow rapid admission from emergency departments for patients that require it.
It argued that no hospital should operate at more than 85 per cent occupancy to ensure patient safety and provide for seasonal surges in demand.
“Just 10,643 public in-patient beds currently exist within the Irish health system, 1,480 less than a decade ago, when in-patient bed numbers stood at 12,123. While there has been some increase in the number of day-case beds since 2007 (1,545 to 2,150), this does not compensate for overall loss of beds to the system over the past 10 years.”
