Healthcare Services in Ireland

Structure of Healthcare Services in Ireland

• Primary care is the first point of contact for patients, focused on keeping people well, including health promotion, screening, and treatment.
• Primary care teams include GPs, nurses, midwives, pharmacists, physiotherapists, occupational therapists, and more.
• Secondary and tertiary care provide specialized services for more complex cases and patients that require advanced intervention.

Access to Healthcare in Ireland

• Ireland has a tiered system of healthcare access:
  • Medical Card: Provides free GP care and primary care services to individuals based on means testing or exceptional medical needs.
  • GP Visit Card: Provides free GP care to individuals based on age or other criteria but require payment for other primary care services.
  • Private: Individuals pay for GP care and primary care services.

General Practice in Ireland

• There are approximately 4,000 GPs in Ireland, with a 50:50 gender split.
• Most GPs work in group practices with clinics located in health centers or purpose-built buildings.

Characteristics of General Practice

• Barbara Starfield identified four central features of effective primary care:
  • First Contact: The first point of contact for all care needs
  • Continuous Care: Person-centered care, not just disease-focused
  • Comprehensive Care: Providing care for all common needs
  • Coordination: Coordinating care for all patients
  • General practitioners manage a variety of presentations with only a small proportion requiring hospital referral.

General Practice in Bahrain

• General practice is known as family medicine and is the cornerstone of Bahrain’s healthcare system.
• Family physicians in Bahrain undergo a lengthy training program, including residency and clinical masters programs.
• Primary care is accessible to all citizens and includes management of acute and chronic illnesses, urgent care, lab services, pharmacy services, social services, and referral services.

RCSI Department of GP and the Medical Course

• The Department of General Practice teaches communication skills, examination skills, professionalism, introduction to prescribing, and clinical decision-making in years 1 and 2.
• The department offers a 6-week rotation in year 4.

Communication Skills in Year 1

• Communication skills are taught using the Calgary Cambridge Model of consultation.

Examination Skills in Year 1

• Examination skills are taught through lectures and small group tutorials.

Assessment in Year 1

• Assessment in Year 1 includes knowledge checks, clinical skills evaluations, and OSCEs.

Early Patient Contact

• Early Patient Contact aims to:
  • Develop an appreciation of the difference between studying and experiential learning
  • Understand the importance of considering patients’ experience of illness
  • Learn the importance of listening to patients
  • Understand the importance of managing emotions and thoughts
  • Learn about professional responsibilities and professional identity
  • Understand the importance of the patient-doctor relationship and patient-centered care

EPC: The Illness Experience

• It is crucial to understand the patient’s experience of illness, which includes their:
  • Ideas about the cause of illness
  • Concerns about the presenting illness
  • Expectations for assistance
  • Effects of illness on their lives

EPC: Doctor-Patient Relationship

• The doctor-patient relationship is built on:
  • Continuity
  • Respect
  • Hope
  • Compassion
  • Trust
  • Self-awareness
  • Healing
  • Transference and counter-transference
  • Patient-centered care

EPC: Patient-Centered Care

• Patient-centered care focuses on:
  • Good patient-doctor communication
  • Accurate diagnosis and understanding of illness experience
  • Effective treatment plan with good adherence
  • Patient and physician satisfaction

EPC: Professionalism

• Students are expected to demonstrate professionalism in all interactions with patients, including:
  • Punctuality
  • Confidentiality
  • Respectful and appropriate behavior

Healthcare Symposia

• Students participate in Healthcare Symposia (HCS) where they meet patients with chronic conditions.
• These sessions provide students with an opportunity to:
  • Understand the impact of illness on patients' lives and families
  • Ask questions about the patients' experiences
  • Learn about patients' perspectives on healthcare
  • Respect patient confidentiality
  • Not record any video or audio of the sessions

Structure of Healthcare Services in Ireland

• Tertiary care (hospitals) and secondary care (specialist clinics) are built on the foundation of primary care.
• Primary care represents the first point of contact for patients, providing accessible services for health promotion, disease screening, assessment, diagnosis, treatment, and rehabilitation.
• Self-care is the foundation of the healthcare system, with primary care building upon it.
• Primary care commonly encompasses General Practice (GPs) and Family Medicine, but also includes a wider range of services.

Primary Care Teams in Ireland

• Primary care teams are composed of various healthcare professionals:
  • GPs
  • Nurses and Midwives
  • Healthcare Assistants
  • Home Help
  • Community Welfare Officers
  • Physiotherapists
  • Occupational Therapists
  • Social Workers
  • Dietitians
  • Dentists
  • Podiatrists
  • Psychologists/Therapists
  • Speech & Language Therapists
  • Receptionists
  • Clerical/Administrative Staff

Access to Healthcare in Ireland

• Eligibility for healthcare services in Ireland is determined primarily through a means-tested system:
  • Medical Card Holders:
    • Free GP care (including out-of-hours)
    • Free primary care services (but waiting lists and some services may be unavailable)
    • Free medication (small fee for "prescription charge")
  • General GP Visit Card Holders:
    • Means tested; applicable for ages 8-69.
    • Free GP care (including out-of-hours)
    • Payment required for other primary care services (e.g., physiotherapy)
    • Payment for medications, but capped at €80 per month per family through the Drug Payment Scheme.
  • Specific GP Visit Card Holders:
    • Available for those under 8, over 70, and carers
    • Expansion to specific population categories occurs.
• Private healthcare is also an option:
  • Patients pay for GP care (~€55 per consultation).
  • Patients pay for primary care services.
  • Patients pay for medications with a €80/month cap per family through the Drug Payment Scheme.

General Practice in Ireland

• Approximately 4000 GPs in Ireland, with 200 GP trainees qualifying annually.
• There is a significant shortfall of GPs, with 700 GPs expected to retire in the next 5 years.
• The gender split among GPs is roughly 50:50.
• Most GPs work in group practices, with GP clinics located in different settings:
  • Health Centres
  • Primary Care Centres
  • Purpose-Built Facilities
  • Converted Houses

Characteristics of General Practice

• Barbara Starfield identified four central features of effective primary care:
  • First Contact: The point of initial contact for all care needs.
  • Continuous Care: Focus on the individuals rather than specific diseases.
  • Comprehensive Care: Providing care for all common needs.
  • Coordination: Coordination of care is provided for all patients.

A Typical Morning in a Doctor's Clinic

• A typical day in a GP clinic involves a variety of patient presentations, diverse age groups, and a range of complaints.
• The number of patients per day varies but averages around 25-30.
• Consultations typically last 12-15 minutes.
• Referrals to physiotherapy or hospital are common.
• First-time patients are integrated into the healthcare system through the GP.

General Practice in Bahrain

• General Practice, Family Medicine, and Primary Care are synonymous terms in Bahrain.
• Family Physicians in Bahrain:
  • Complete a 1-year internship followed by a 4-year residency training program.
  • Acquire Arab Board Certification.
  • Participate in a 2-year clinical masters program with the Arabian Gulf University (AGU).
  • Female physicians outnumber male physicians.
• Public Sector:
  • Primary Care Centres: Approximately 28, including 9 available 24/7.
• Private Sector:
  • Family Physicians and GPs operate privately.

Primary Healthcare in Bahrain:

• Primary healthcare is considered the cornerstone of the healthcare system in the Kingdom of Bahrain.
• The country has adopted the Universal Declaration of Alma-Ata (1978) and the Astana Declaration (2018) to achieve universal health coverage.
• Access to primary care is crucial for attaining health for all as outlined in the global health strategy.

Access to GP in the Kingdom of Bahrain

• Primary care represents the first point of contact for individuals in Bahrain.
• Access to primary care is free for all citizens.
• Primary care centers provide a wide range of services:
  • Management of acute illnesses
  • Management and follow-up of chronic illnesses
  • Urgent care
  • Laboratory and X-ray services
  • Pharmaceutical services
  • Social services
  • Physiotherapy and dental services
  • Referral services to secondary care hospitals (if needed)
  • Preventative services:
    • Antenatal services
    • Periodic Child Screening
    • Immunization
    • Post-natal/post-miscarriage services
    • Family Planning services
    • Periodic Women’s Screening services
    • Pre-Marital services
    • Ultrasound screening for pregnant women

RCSI Department of GP and the Medical Course

• The Department of General Practice plays a significant role in teaching and educating students throughout the medical program.

GP Department Teaching in Years 1 & 2

• The Department of General Practice teaches:
  • Communication skills:
    • Utilizing the Calgary Cambridge Model for consultations.
  • Examination skills:
    • Practical assessments focusing on different body systems.
  • Professionalism:
    • Introduction to the concepts of professionalism.
  • Introduction to Prescribing and Clinical Decision Making:
    • Foundational knowledge for future prescribing practices.
  • Early Patient Contact:
    • Direct encounters with patients.

GP Department in Later Years

• Year 3: Students participate in a selected component, which includes a 6-week rotation at a GP practice.
• Year 4: Students undertake a comprehensive GP module, building on prior knowledge.

Communication Skills in Year 1

• Communication skills are taught through various formats:
  • Lectures:
    • Focusing on the Calgary Cambridge Model for consultations.
    • Utilizes system folders as resources.
  • Small Group Tutorials:
    • Formal history taking and structured consultations.
    • Uses patient scenarios to practice skills.

Examination Skills in Year 1

• Examination skills are delivered through:
  • Lectures:
    • Focusing on specific exams (e.g., BMF - Knee and PNS exams, CVS exam, RESP exam).
    • Uses system folders as resources.
  • Small Group Tutorials:
    • Guided practice using task lists to enhance skills.

Assessment in Year 1

• Year 1 assessment incorporates:
  • Knowledge Checks: Assessing theoretical understanding.
  • Clinical Skills Evaluations: Practical assessment of clinical skills.
  • Progress Tests: Evaluating longitudinal progress.
  • OSCEs: Objective Structured Clinical Examinations.
  • Attendance: Regular attendance is essential for successful progression.

Early Patient Contact

• Early Patient Contact (EPC) provides students with a unique perspective on medicine.
• EPC offers valuable learning opportunities:
  • Developing an appreciation for the difference between academic learning and experiential learning.
  • Understanding the significance of considering the patient's experience of illness.
  • Learning to empathize with the patient (compassion and empathy).
  • Recognizing the importance of active listening.
  • Understanding the doctor's professional responsibilities and exploring one's own professional identity.
  • Recognizing the crucial role of the patient-doctor relationship and patient-centered care.
  • Maintaining respect and professionalism at all times.
  • Managing personal emotions and thoughts, promoting self-care.

EPC: The Illness Experience

• Understanding the patient's experience of illness is central to effective medical practice.
• The Calgary Cambridge Model is used to guide communication with patients, focusing on four key areas:
  • Ideas: Patient's beliefs about the cause of illness.
  • Concerns: Patient's worries about the presenting illness.
  • Expectations: Patient's anticipated assistance for the illness.
  • Effects: The impact of illness on the patient's life

EPC: Doctor-Patient Relationship

• The patient-doctor relationship is a crucial aspect of healthcare.
• Key characteristics of a successful relationship include:
  • Continuity
  • Respect
  • Hope
  • Compassion
  • Trust
  • Physician Self-awareness
  • Healing
  • Transference and Countertransference

EPC: Patient-Centered Care

• Patient-centered care emphasizes patient needs and preferences:
  • Good communication between patient and physician
  • Accurate diagnosis and understanding of the patient's illness experience
  • Effective treatment plan with good patient adherence.

EPC: Professionalism

• Maintaining professionalism is essential in the medical field.
• Key facets of professional conduct include:
  • Punctuality
  • Confidentiality
  • Respectful behavior and demeanor.
  • Giving patients your undivided attention.

Structure of Healthcare Services

• Primary care is a broad approach to health care, including health promotion, disease screening, assessment, diagnosis, treatment, rehabilitation, and personal social services.
• Primary care is easily accessible, with an emphasis on working with individuals and communities to improve their health.
• Primary care services are often synonymous with general practice (GP) or family medicine.
• Primary care teams consist of various healthcare professionals alongside a General Practitioner (GP), such as nurses, midwives, pharmacists, physiotherapists, occupational therapists, and social workers.

Access to Healthcare in Ireland

• Healthcare in Ireland broadly falls under Medical Card patients, GP Visit Card patients, and Private patients.
• Medical Cards are "means tested" and provide free GP care, including out-of-hours care, free primary care services, and free medications subject to a small prescription charge.
• GP Visit Cards are also means tested for individuals aged 8-69 and provide free GP care, including out-of-hours care, but payment is required for other primary care services and medications.
• Private patients pay for all GP care and primary care services with a maximum drug payment scheme of €80 per month per family.

General Practice in Ireland

• There are approximately 4000 GPs in Ireland, with about 200 GP trainees qualifying each year.
• Approximately 700 GPs are expected to retire within the next 5 years.
• The gender split among Irish GPs is roughly 50:50.
• Most GPs operate in group practices located in health centers, primary care centers, or purpose-built buildings.

Characteristics of General Practice

• Barbara Starfield identified four central features of effective primary care:
  • First Contact: The primary point of contact for all healthcare needs.
  • Continuous care: Focused on the individual rather than individual diseases.
  • Comprehensiveness: Providing care for all common healthcare needs.
  • Coordination: Coordinating care plans across all medical needs.

General Practice in Bahrain

• General Practice, Family Medicine, and Primary Care are often used synonymously in Bahrain.
• Family Physicians/Consultant Family Physicians play a crucial role in the Bahrain healthcare system.
• Family Medicine in Bahrain involves a 1-year internship followed by a 4-year residency training program, concluding with Arab Board certification.
• A 2-year clinical masters program exists in collaboration with the Arabian Gulf University (AGU).
• The ratio of female to male Family Physicians is higher than in other regions of the world.

Access to GP in the Kingdom of Bahrain

• Primary Care is the first point of contact for individuals in Bahrain and is accessible for all citizens.
• Primary Care Centers offer a range of services, including management of acute and chronic illnesses, urgent care, laboratory and X-ray services, pharmaceutical services, social services, physiotherapy, dental services, referral services, and preventative measures.

RCSI Department of GP and the Medical Course

• The RCSI Department of GP integrates teaching throughout the medical course, starting in Year 1 and continuing through Year 4.

GP Department teaching in years 1 and 2

• The GP Department focuses on crucial skills in Year 1 and 2, including:
  • Communication Skills, utilizing the Calgary Cambridge consultation model.
  • Examination Skills, incorporating practical experience and assessments.
  • Professionalism, emphasizing key aspects like punctuality, confidentiality, and respectful behavior.
  • Introduction to Prescribing and clinical decision-making, preparing students for future prescribing roles.
  • Early Patient Contact (EPC), providing first-hand experience with interacting with real patients.

GP Department in Later Years

• Year 3 involves a student-selected component of the course.
• Year 4 includes a 6-week GP module and a mandatory 6-week GP rotation.

Communication Skills in Year 1

• Students are introduced to the Calgary Cambridge consultation model.
• Practical application of the model is facilitated through small group tutorials and patient scenarios.

Examination Skills in Year 1

• Lectures provide foundational knowledge on examining techniques, specifically focusing on examining the knee and peripheral nervous system (PNS), cardiovascular system (CVS), and respiratory system (RESP).
• Small group tutorials provide practical training with task lists for each system.

Assessment in Year 1

• Assessment in year 1 is comprehensive, combining:
  • Knowledge checks: Assessing theoretical knowledge.
  • Clinical Skills Evaluations: Evaluating practical skills in the clinical setting.
  • Progress Tests: Comprehensive evaluations of both knowledge and skills.
  • Objective Structured Clinical Examinations (OSCEs): Simulated clinical encounters, assessed independently.
  • Attendance: Evaluating regular participation in teaching sessions.

Early Patient Contact (EPC)

• EPC is integral to the study of medicine, differentiating between theoretical learning and real-world application.
• EPC emphasizes understanding the patient's lived experience with illness, prompting empathy and compassion.
• EPC reinforces the importance of active listening, recognizing the power of the patient-doctor relationship.
• EPC encourages students to develop a strong sense of professional responsibility and responsibility, being aware of their own emotional and physical well-being.

The Illness Experience and EPC

• It's crucial to comprehend the patient's experience with illness, which is a key component of successful medical practice.
• EPC provides a framework for understanding the patient's perspective, encompassing their:
  • Ideas: Beliefs about the cause of illness.
  • Concerns: Worries related to the presenting illness.
  • Expectations: Anticipated assistance for the illness.
  • Effects: Impact of illness on the patient's life.

EPC and Patient-Doctor Relationship

• The patient-doctor relationship is a foundation of healthcare, built on mutual respect, trust, compassion, and hope.
• The relationship is deeply personal, with factors like transference and countertransference influencing interactions.
• It's vital for both patient and doctor to feel heard, understood, and respected, emphasizing empathy and open communication.

EPC and Patient-Centered Care

• Patient-centered care prioritizes the individual's unique needs and preferences, putting the patient at the center of the decision-making process.
• EPC promotes effective communication and a strong rapport between the physician and patient.
• It fosters a deeper understanding of the patient's illness experience, leading to more accurate diagnoses and treatment plans.
• Patient-centered care aims for high patient satisfaction and adherence to treatment.

This quiz covers the structure of healthcare services in Ireland, including the roles of primary, secondary, and tertiary care. It explores access to healthcare through various cards and the general practice landscape in the country. Test your knowledge on how healthcare is organized and delivered in Ireland.