Ireland on the brink...how can health professionals help???

Nchd2010 · 30-09-2010 02:40PM #1

Seeing as the government has essentially nationalised the states second largest bank, and the health service is one of the largest areas of expenditure, just wondering if any health professionals out there have any ideas on how we, as professionals with ethical commitments can help our country. I have a few suggestions:

1 Stop paying radiographers more than doctors just to take pictures. In fairness, there's a bit of skill involved in ultrasonography, but really, charging €200 plus standard overtime for an on call CT seems a bit much

2 Stop wasting money on unnecessary tests. Not everyone with chest pain and elevated FDP needs a CTPA. Not everyone with chest pain needs a chest x ray.
LFTs, U/E, FBC most likely do not need to be repeated on a daily basis.

3 Prescribe generically

4 IV meds are far more expensive in most cases. Use po paracetamol and ppi's, there's literature to support this.

5 Stop using colloid. Unless absolutely necessary. It's expensive, causes allergic responses, and not supported by a sufficient body of evidence.

6 Be nice to your fellow professionals. It'll improve morale.

chanste · 30-09-2010 05:11PM

I have to applaud the patriotism here! And it must be said we would be generally better off to adopt this mentality in every other industry too!

We live in a great country (political views aside) lets do our bit.

Being a med student I can't do any of the things on your list though

bleg · 30-09-2010 05:48PM

We can extract a 50c levy on behalf of the state for every prescription item that cancer sufferers, homeless people and other people with a medical card.

Nchd2010 · 01-10-2010 03:45AM

Tbf, I really don't think cynicism serves any purpose. Tbf, the availability of drugs like temsirolimus, sumatinib, sunitinib etc, and even bevacizumab in metastatic cancer really is astounding in a small country. Even if it is strictly regulated by ICORG. NICE guidelines don't really support these advances so in fairness, a €0.50 levy seems somewhat reasonable.

Though there has to be a better way than targetting the old and the sick.

Traumadoc · 01-10-2010 11:34AM

NICE guidelines do not support stress tests :rolleyes:

Nchd2010 · 01-10-2010 12:47PM

Really? Did NOT know that. Tbf i've always wondered about stress tests really. Either patient is low risk and doesn't require investigation, or they're high risk and require either invasive or non-invasive imaging.

Have you any idea what kind of literature backs this up? (the NICE guideline, not my surmising)

bleg · 01-10-2010 01:38PM

Chemotherapy is provided for the most part under the High Tech scheme. It's the additional meds that cancer sufferers will now have to pay for.

Traumadoc · 01-10-2010 02:18PM

Nchd2010 wrote: »

Really? Did NOT know that. Tbf i've always wondered about stress tests really. Either patient is low risk and doesn't require investigation, or they're high risk and require either invasive or non-invasive imaging.

Have you any idea what kind of literature backs this up? (the NICE guideline, not my surmising)

I think everyone low or high risk requires investiogation

http://www.nice.org.uk/nicemedia/live/12947/47938/47938.pdf

do not give oxygen either.

ThatDrGuy · 03-10-2010 03:00AM

Me remembers the handing over of a list of over 200 methods of saving money for a certain hospital last year to management by the NCHDs. It was tossed in the bin. You might prescribe generically all you want, doesnt mean the chemist will dispense it. Radiographers have a union, you dont - no one will touch them. Cost of CTPA around 300 euro. Cost of missing a PE, several hundred thousand euro and your career. Most of our fellow "professionals" are heavily unionised lazy ass drones who we subsidise mightily by working obscene amounts of overtime (largely for free these days). Moral is low because things are $hit and getting worse by the day. Massive amounts of the 700 million in cuts will be levied on doc's because we are the weakest link. Get out while you can.

Chuchoter · 03-10-2010 10:17AM

bleg wrote: »

We can extract a 50c levy on behalf of the state for every prescription item that cancer sufferers, homeless people and other people with a medical card.

To be honest thats a bit silly. 50c is nothing. You can't even get coffee for that.

RobFowl · 03-10-2010 11:29AM

crayolastereo wrote: »

To be honest thats a bit silly. 50c is nothing. You can't even get coffee for that.

It's 50c now but already nutterings that it'll increase in the next budget.

opinion guy · 03-10-2010 11:33AM

To be honest I don't think this 50c thing is so bad. IT has a max of 10euro per month per family and people are getting drugs worth hundreds at a max of 120eur per month

bleg · 03-10-2010 12:38PM

opinion guy wrote: »

To be honest I don't think this 50c thing is so bad. IT has a max of 10euro per month per family and people are getting drugs worth hundreds at a max of 120eur per month

You don't have a clue.

opinion guy · 03-10-2010 12:47PM

bleg wrote: »

You don't have a clue.

Thank you for that intelligent contribution. Care to comment on what I actually said instead of attacking me ?

anotherlostie · 03-10-2010 02:50PM

I believe that the real savings from the GMS tax will come about in relation to a reduced drug spend rather than the money the tax collects (are pharmacists getting anything extra for the extra admin/ hassle on this by the way?)

When an elderly relation of mine died, we found a mountain of unopened medication in his house - doctor wrote script and he got everything, regardless of whether or not he needed it (inhalers and eye drops being classic examples of where a monthly repeat is not necessarily needed). If people have to pay something, it might make them more judicious in asking for what they need rather than getting their entitlement, and there's potential for huge saving here.

Of course the flip side is that people might not take their medicine, but the two people I know who have argued this with me both have money to go out boozing at the weekend, every weekend, so two drinks less and there's your €10. Unfortunately our extremely generous benefits system is going to have to be cut back and yes it's tough but what about the people just above the threshold who pay €120 a month when it used to be €42 less than 10yrs ago.

opinion guy · 03-10-2010 04:04PM

anotherlostie wrote: »

When an elderly relation of mine died, we found a mountain of unopened medication in his house - doctor wrote script and he got everything, regardless of whether or not he needed it (inhalers and eye drops being classic examples of where a monthly repeat is not necessarily needed). If people have to pay something, it might make them more judicious in asking for what they need rather than getting their entitlement, and there's potential for huge saving here.

In fairness thou - this is an argument for centralized computerized prescribing, no? How does one doctor know what the other has prescribed otherwise?

Of course the flip side is that people might not take their medicine, but the two people I know who have argued this with me both have money to go out boozing at the weekend, every weekend, so two drinks less and there's your €10. Unfortunately our extremely generous benefits system is going to have to be cut back and yes it's tough but what about the people just above the threshold who pay €120 a month when it used to be €42 less than 10yrs ago.

Fair point

Kurtosis · 03-10-2010 07:54PM

The 50c levy tries to address over-prescribing/dispensing by making patients decide what medicines to get based on their financial means. How our Minister for Health thought this would be the most effective measure, I do not know...it's just another instance of lazy decision making.

People who have the money will have no problem paying and will continue to get all their medicines dispensed. Those who do not have the money will probably choose to get the medicines they perceive to have the largest effect (symptomatic relief) and may neglect some important prophylactic medicines, leading to increased long term complications with their condition.

For people who have a stockpile of medicines, this levy may prevent further items being dispensed, but does not address the issue of why they have an excess of certain medicines. Are they not taking them at all? Are they not taking the prescribed dosage? Is the medicine being over-prescribed? Covering up these issues is not going to result in improved clinical outcomes for any patients.

A more effective solution (though obviously more complex) should involve the patient and healthcare professionals involved in their care regularly discussing and reviewing the patient's therapy in a structured manner.

bleg · 03-10-2010 08:57PM

We just asked people in the pharmacy if they wanted everything as they handed in/ordered their scripts.

The 50c levy may not even cover the costs of its administration and wastes pharmacists time when health policy is to free up their time to make them more available for other tasks.

There is no cap at 10 euro a month. If you go over, you still pay. You can then have to fill out a form and send it off (another 50c) to the Primary Care Reimbursement Service. The head of the PCRS has said that his organisation will not reimburse anybody less than 5 euro.

The Dept for Health and Children recently commissioned an independent report to look at primary care funding.
http://www.dohc.ie/publications/resource_allocation_financing_health_sector.html

The authors of this report stated:

“In the view of the group, the recently introduced capped co-payment for prescriptions for medical card holders is unlikely to meet the criterion of raising enough revenue to justify the administration costs,” the report said.

“Evidence suggests that any deterrent effects will be to reduce the use of both necessary and less necessary drugs, with possible harmful effects on health.”

http://www.irishtimes.com/newspaper/ireland/2010/0710/1224274419367.html?via=rel

Lets recap: with the imposition of the 50c charge Mary Harney is ignoring the advice of GPs, pharmacists, patients and also the expert group that she charged with investigating resource funding in Irish Healthcare. Her move also flies in the face of international best practice.

People will probably stop taking their statins and BP meds as they have no directly observable effect. Pretty shocking in a country like Ireland with a high incidence of cardiovascular disease.

It makes no sense.
None at all.

Nonoperational · 03-10-2010 10:21PM

Bleg I completely disagree with you.

anotherlostie · 03-10-2010 11:38PM

opinion guy wrote: »

In fairness thou - this is an argument for centralized computerized prescribing, no? How does one doctor know what the other has prescribed otherwise?

It was a one horse village, so it would have been the same GP month after month, giving the same script (and probably a three month one). Maybe if people start telling their GP's that they don't need 'that one', compliance issues might become more readily addressed than they clearly were at the time my relative was taking his medication as there were 'ongoing' tablets among the stock pile.

I can't believe the €10 cap is not there from the start - it's not like there wasn't time to plan for this! Though I don't think there are two many families with more than 20 items per month though when I was in the business I never worked in an area with a very high GMS base. But I'm still curious as to what, if any, additional payment the pharmacist is getting for this, and Bleg didn't address that in his/her detailed response. And who knows, maybe a few benevolent pharmacists will waive the fees for their regular patients who may be in desperate straits, though the guys in the Pharmaceutical Society ivory towers would probably deem this unethical!

bleg · 03-10-2010 11:43PM

No, pharmacists get no additional payment for doing this and yes some will pay the fee for people in dire straits i.e. out of their own turnover.

opinion guy · 04-10-2010 12:14AM

bleg wrote: »

There is no cap at 10 euro a month. If you go over, you still pay. You can then have to fill out a form and send it off (another 50c) to the Primary Care Reimbursement Service. The head of the PCRS has said that his organisation will not reimburse anybody less than 5 euro.

Sorry I dunno I just heard Harney on the radio saying there was a 10 euro a month limit. Was she skirting over the fine details ??

bleg · 04-10-2010 12:29AM

opinion guy wrote: »

Sorry I dunno I just heard Harney on the radio saying there was a 10 euro a month limit. Was she skirting over the fine details ??

She was. The technical nature of the PCRS payments mean that you have to go into the finer detail. Journalists generally tend not to go into detail about these details as it's pretty boring stuff.

JuliusCaesar · 04-10-2010 09:45AM

ThatDrGuy wrote: »

Me remembers the handing over of a list of over 200 methods of saving money for a certain hospital last year to management by the NCHDs. It was tossed in the bin. You might prescribe generically all you want, doesnt mean the chemist will dispense it. Radiographers have a union, you dont - no one will touch them. Cost of CTPA around 300 euro. Cost of missing a PE, several hundred thousand euro and your career. Most of our fellow "professionals" are heavily unionised lazy ass drones who we subsidise mightily by working obscene amounts of overtime (largely for free these days). Moral is low because things are $hit and getting worse by the day. Massive amounts of the 700 million in cuts will be levied on doc's because we are the weakest link. Get out while you can.

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

knipex · 04-10-2010 10:22AM

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

Doesn't change the fact that in general terms he is correct.

NCHD's are an easy target and tend to get screwed when other sectors get protected.

Hospital cleaners on 30 to 35K plus overtime and allowances.
Electricians going to strike because other staff were allowed to change light bulbs or because they were no longer going to be paid a call-out fee to press a button on an alarm panel.
Nurses striking for a 35 hour week and a 10% pay increase (a staff nurse starts on €30,234 rising automatically to €43,800 plus allowances and overtime).
Porters on 35K plus that can never be found.
16% plus absenteeism in some hospitals.

In general terms its hard to dispute the evidence.

SleepDoc · 04-10-2010 11:53AM

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

So what? He/she may not win an award for diplomacy but their comments were pretty spot on.

beagle001 · 04-10-2010 12:00PM

Get rid of all the contract agencies operating in the hospitals and re hire the contractors on a part time basis.
If thats not legal then advertise the jobs

tallaght01 · 04-10-2010 12:17PM

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'?

Which is just as much of a generalisation as anything said by the doc above.

Nchd2010 · 04-10-2010 08:45PM

I deliberately didn't mention porters in the opening post, because it really is too obvious a target for cost savings. Before I go on, I will say that I have often worked with some really nice guys, with a genuine dedication to the job and a desire to work for patients...

But on the other hand, some porters are earning easily €70-80k a year, for a non-skilled, manual job. A lot of people find this difficult to believe. The chicanery of some calling in sick, so that someone else gets to work overtime etc really is galling.

As I said, a lot of non-medical friends are incredulous at the amount of money porters are on, but I always point out that the other non-skilled workers in hospitals, the cleaners, are privatised, are almost exclusively non-Irish and are probably saving a fortune for the hospitals.

opinion guy · 04-10-2010 08:59PM

Nchd2010 wrote: »

€70-80k

What@?@?@?@?@:eek::eek:

Nchd2010 · 04-10-2010 09:09PM

Yeah and to make it even better, it's essentially a public sector job, almost impossible to get sacked, with a defined benefits pension and a militant union. And if you're in with the boss, it's fairly easy to get jobs for the rest of your family. Obviously that's before the hiring freeze.

Ireland on the brink...how can health professionals help???

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