Solution to Waiting Lists?

laserlad2010

Disclaimer - I'm a Paediatric SPR so I'll be looking at this from doctor POV.

I'm interested in hearing other Healthcare Profession viewpoints on this.

Basically Macedonia and Serbia have introduced an e-booking system which allows GPs to directly book slots with consultant specialists and which allegedly has reduced waiting lists considerably.

Whilst I feel a certain element of this plan would be fantastic (e.g. allowing GPs to electronically book radiology etc.) I would, as a consultant, resent having a teenager with a simple tension headache book themselves in for an appointment in two weeks time and thus deny that appointment that a suspicious lump or rash might need.

Personally I would still feel that hospital medicine needs to regulate such a system to ensure that the people who need to be seen quickest, are. I am in no way defending the current system by the way, it's a shambles but I have made a certain amount of peace with it because (a) I have no control over it and (b) I need to preserve my mental health!

http://www.thejournal.ie/macedonia-ebooking-appointments-3241397-Feb2017/

RobFowl

Am a GP fwiw.
It comes down to whether you trust GP's to properly triage.
I feel we as a profession are more than capable of this.
At present urgent cases are simply not seen fast unless there are a series of pleading calls and repeated letters and often the last resort of referring people to AE.
The AE option is unfair on the staff there but is often the only option due to the difficulty getting appointments.
There is no suggestion that teenagers with aheadche can book them selves in anywhere other than with their GP.
GP's and AE staf are the only front-line doctors who have no real barriers for patients. They are able to book appointments directly and with little if any real wait. This works well and in Primary care we often feel docs in secondary care erect barriers designed to make their clinics work better rather than to allow patients with urgent problems get access..
Secondary care in Ireland is truly a doctor centric model and certainly not one that could be called patient centred..

laserlad2010

The situation I'm outlining is that a teenager comes to a GP practice with tension headaches, the GP says I'll send you to a paediatrician - oh look there's a slot in two weeks let's take that. What triage would occur there? Unless everyone could be seen within the same timeframe...

Are you suggesting that GPs by and large would say "oh no, why don't we ignore all of those green vacant slots and give you one in 3 months time?" It's only human nature that people would get what they demand.

Your assertion about barriers to prevent patients accessing care is a misinterpretation of the triage system, and you are ignoring the fact that we can only work with what we are given by the hospital and HSE.

Secondly, I understand GPs often have to send multiple referrals but when 40 letters a week arrive into a department you have to look at the bigger picture, if we had funding for more clinics we could see more patients etc. etc.

Perhaps a compromise would be that routine slots were available to book by GP, and that urgent slots required an email referral??

RobFowl

laserlad2010 wrote: »

The situation I'm outlining is that a teenager comes to a GP practice with tension headaches, the GP says I'll send you to a paediatrician - oh look there's a slot in two weeks let's take that. What triage would occur there? Unless everyone could be seen within the same timeframe...

Are you suggesting that GPs by and large would say "oh no, why don't we ignore all of those green vacant slots and give you one in 3 months time?" It's only human nature that people would get what they demand.

Your assertion about barriers to prevent patients accessing care is a misinterpretation of the triage system, and you are ignoring the fact that we can only work with what we are given by the hospital and HSE.

Secondly, I understand GPs often have to send multiple referrals but when 40 letters a week arrive into a department you have to look at the bigger picture, if we had funding for more clinics we could see more patients etc. etc.

Perhaps a compromise would be that routine slots were available to book by GP, and that urgent slots required an email referral??

2 questions, if a slot was available in 2 week why would or even why should it not be used?
Also if GP's had direct access to imaging etc many referrals would simply not happen.
Secondly offering urgent, semi urgent and routine appointments with triaging by the GP's would allow GP triage.
When you work in Primary care and see letters coming back offering patinets appointments in 2 years time or refusing to see patients you can understand the anger among primary care frontline workers and patients.

laserlad2010

RobFowl wrote: »

2 questions, if a slot was available in 2 week why would or even why should it not be used?
Also if GP's had direct access to imaging etc many referrals would simply not happen.
Secondly offering urgent, semi urgent and routine appointments with triaging by the GP's would allow GP triage.
When you work in Primary care and see letters coming back offering patinets appointments in 2 years time or refusing to see patients you can understand the anger among primary care frontline workers and patients.

Absolutely, I'm not defending the current practice.

That's a good point - I was concerned we couldn't allow for urgent referrals but if we only offer routine appointments by an website method then I suppose the 2 week slot is fair game:D

Why do these patients get offered appointments in 2 years time? Lets say there are 20 slots in a clinic. 4 of these are allocated to new referrals, 16 to return patients. That means that your patient joined a list, the next slot is available in 2 years. It is not your fault. It is not my fault. It is the fault of HSE planning who haven't hired the staff or funded the clinics for a particular region.

Do GPs not already have direct access to imaging? Any hospital I've worked in has allowed Xray/US/CT at a miminum. Perhaps MRI too. What's your experience?

RobFowl

laserlad2010 wrote: »

Do GPs not already have direct access to imaging? Any hospital I've worked in has allowed Xray/US/CT at a miminum. Perhaps MRI too. What's your experience?

GP's have access to X ray in most areas, USS is some (Drogheda for an example refuses GP access to USS) and no area I am aware of allows GP access to CT or MRI.

Of course these can all be sourced privately in a mater of days or weeks.....

laserlad2010

RobFowl wrote: »

GP's have access to X ray in most areas, USS is some (Drogheda for an example refuses GP access to USS) and no area I am aware of allows GP access to CT or MRI.

Of course these can all be sourced privately in a mater of days or weeks.....

I would feel that ultrasound access should be national...

In your experience, how many of the, say, MRI scans your patients get done privately have any significant findings?

That would be an interesting audit.

RobFowl

laserlad2010 wrote: »

I would feel that ultrasound access should be national...

In your experience, how many of the, say, MRI scans your patients get done privately have any significant findings?

That would be an interesting audit.

Probably most if not all, near in mind a "normal" MRI esp of the brain is the significant find we often need (and want !)

laserlad2010

RobFowl wrote: »

Probably most if not all, near in mind a "normal" MRI esp of the brain is the significant find we often need (and want !)

Yes indeed. However, wouldn't it be interesting to see how many of those people would actually have been referred for imaging by a specialist?

I suppose it's semantics. My dad is a GP. He's probably the best one I've ever met, and I've met a lot (admiration of my father aside). I appreciate, probably more than most, the abilities and wasted potential of primary care.

I'm just looking at it from a national health system POV. How many scans would have been done by specialists that were requested by GPs? It's an interesting question and the answer could force the HSEs hand.

hardanro

I don't understand why waiting lists should exist in the first place?
I used to live in a country without waiting lists. The old fashioned way: get a letter from GP, go to a hospital (any hospital) where consultants had 2 hours every morning for ambulatory consultation. The visit didn't usually took more than 10 minutes, but in that time he could ases the seriousness of the condition, and could decide wether a patient need to be move to a hospital bed, order some scans and arrange a follow-up, or just to be sent home with some pills prescribed.
The whole system seemed to be working so much better than waiting list system. A patient could be seen by a specialist in less than a week.
For those complaining that this will waste the specialist time: the patient had already been through a triage (GP referal) and the urgency could be better established by the specialist by seeing the patient than to rely on 1000's of different opinions from GP. What is urgent for one might be routine for other, especially when no clear guidelines or standards exists.
The problems with waiting list are: lack of transparency and that more time is allocated than the actual visit will take.
Let's take for example blood tests at mater hospital. A blood test usually take 2 minutes, but they allocated 10 minutes time slots. So, instead of booking 200 patients/day/nurse, only 40/day an have their blood test done. Beside that, you can only book from one month from now. This is unnecesarry delaying for a simple service that, in other country, is done in walk-in clinics.
So, what's the real benefits of waiting lists? To manage priority? I would prefer being seen non-urgent in 1 week, than to be seen urgently in 1 year.
How does private health manage to have appointments done in 2 weeks without waiting lists, using less resources?

RobFowl

If you don't min hardanro what country was that?
Don't answer if you prefer not to saw but I would be very interested.
Rob

Killergreene

Gp practices are severely oversubscribed and understaffed. It's handier for GP just to send rubbish into a and e if they think they can't manage it with an antibiotic or a difene. That's why patients are on trollies and waiting lists are through the roof. Hospital doctors are too busy sifting through crap to find the actual sick people.

RobFowl

Very helpful post there killergreene
Don't post here again unless you have anything constructive to say.
Rob
Moderator note

Dingle_berry

I think all Health Care staff are under utilised compared to their knowledge/skills. Those in charge of hospitals don't trust primary care to triage appropriately for their discipline and don't have the time to give the extra training to those who genuinely can't. So they restrict primary care referrals. Which leads to our current scenario.
All health care professions have leaped ahead of their roles in terms of knowledge in the last 20-30 years. The HSE doesn't want to pay them extra for taking on extra responsibilities and the professionals don't think that's fair. So people get honours degrees to do the same job that was essentially a trade 30 years ago.

hardanro wrote: »

A blood test usually take 2 minutes,

It's nit-picking but that's the phlebotomy that takes 2minutes. And only if the patient has decent veins...

Nonoperational

RobFowl wrote: »

Am a GP fwiw.
It comes down to whether you trust GP's to properly triage.
I feel we as a profession are more than capable of this.
At present urgent cases are simply not seen fast unless there are a series of pleading calls and repeated letters and often the last resort of referring people to AE.
The AE option is unfair on the staff there but is often the only option due to the difficulty getting appointments.
There is no suggestion that teenagers with aheadche can book them selves in anywhere other than with their GP.
GP's and AE staf are the only front-line doctors who have no real barriers for patients. They are able to book appointments directly and with little if any real wait. This works well and in Primary care we often feel docs in secondary care erect barriers designed to make their clinics work better rather than to allow patients with urgent problems get access..
Secondary care in Ireland is truly a doctor centric model and certainly not one that could be called patient centred..

Some yes, some A&E referrals are borderline disgraceful. I don't know if it's complete defensive medicine from people who have been caught out before or if it's just that a number of very poor GPs exist as do poor NCHDs/Consultants/Nurses etc.

Corruptedmorals

Hardanro, because there aren't enough consultants/doctors/clinics for the demand. If you could see the amount of referrals hospitals get per week you would be shocked. Clinic slots are also controlled, a clinic of say 40 will have 25 slots for return patients, 7 for post-operative patients, 3 for A&E direct referrals and the rest for new which is 5. That is why waiting lists get so long. You could have a huge binder bursting with letters and then discover that the letters are for one consultant only, surnames A-D only and are only those who haven't been given an appointment yet. It is crazy.

Arbie

Where I work we receive about 1.5 new referrals for every 1 patient we discharge, so unless we increase staffing by 50% the list will just keep growing. There are still problems with patients not attending which means 80+ missed slots each week. Some patients can only be discharged from clinic under protest as they are scared that they will never get back in the system again. The waiting lists are so bad now that if we want someone back in 6 months we have to request 3-4 months.

GPs are trained to triage and they are good at it, but they can struggle with some specialities, and we still get a lot of inappropriate emergency referrals. My GP friends say some of it is due to lack of experience on the GP's part but much of it is down to GP desperation/exasperation to get the patient seen. I saw a patient recently who was on waiting lists for a procedure in 2 other hospitals and had been sent in by the GP to see if we would also list him in ours!

I've been on waiting lists myself and psychologically it is awful to just be on the list with no date. I would rather know the date even if it's a long time away.

EoghanIRL

I think more of an emphasis should be put on prevention.

Example: I read figures that thousands of patients a year are admitted to have teeth removed under general anaesthetic.
This must put strain on waiting lists, if even in terms of the cost which could be used to pay for extra staff etc..

Better education from an early stage at school about the risks of smoking etc.. which causes a large amount of admissions.

Short term you have to tackle the amount of patients currently waiting.
Long term you need to decrease the amount of patients waiting in the first place through better prevention strategies.

There should be better education about health in schools and from an early age.
Education about general health, oral health and bls.

Daydreamer2105

Hi everyone,
I am currently searching for GPs, consultant, etc. who can bring a doctor's point of view to a workshop that is being run next Saturday by 'Open Knowledge Ireland' a  not for profit organisation campaigning for data that is being collected about & for the public  to be made accessible and released to the public. In December we have reached our goal of getting Hospital Wait Time data released in machine readable data on data.gov.ie.
As a follow-up we have organised a workshop to build ideas around how this data can be used to benefit patients and citizens in Ireland (e.g. easy to access & read dashboards, hospital look-ups by location & wait time, web apps, etc). The workshop will be attended by citizens, patients whom we are putting into groups with people from digital, tech, analytics, and open data SMEs.
We would love to have GPs, consultants, and people who can lend a doctors point of view attend the workshop which is the 1st of a series of workshops so that those who know what can be built using this data can learn from you about what the day to day needs are around hospital wait times for a practitioner.
PM me if you would like more information or would like to attend - we're a small team who have experience in running these type of workshops and are very approachable. 
Event details here: https://openknowledge.ie/events/
Registration for the event here: https://ti.to/open-knowledge-ireland/Waiting-List-Workshop-1
Past events: https://ti.to/open-knowledge-ireland/