Model health project
Heart of the Matter
It is probably the best kept secret in Mayo that Erris is home to a health service project which is a model for the future of community health services nationally.
Nearly five years ago the Government began its reform of the health service. Since then much has changed and a lot has been promised. Unfortunately most people have a negative view of the reform because they fear it will lead to the loss of their hospital services.
But the reform contains the potential for an improvement in service and one area earmarked is primary care. To many people the term primary care is confusing health service jargon. In reality it is health care delivered in communities by GPs, public health nurses, home helps, physiotherapists and dieticians.
In 2001 the Government launched a Primary Care Strategy to bring together these various elements to provide more comprehensive services to communities. It took several months for the strategy to take effect and nearly a year later the former Minister for Health and Children, Micheál Martin announced that pilot projects would be set up and would share funding of €8 million.
“There is a wealth of international evidence that team-based primary care is better for both patients and providers. Many other countries are introducing or have already introduced similar reforms,” he added.
Four years ago this month it was decided that one of these projects would go to Mayo. The Erris Primary Care Team was set up to serve a population of 8,500 in a mainly rural area. Many patients are elderly and most people have medical cards. Poor nutrition among the elderly, mental health problems due to isolation, suicide and bereavement, women’s health and long distance were identified as the priorities.
It was envisaged that the Erris team would be made up of four GPs, their staff and HSE Western Area nursing, health and social care professionals and administrative personnel. Services were supposed to be provided from a number of locations and team members are based in Bangor Erris and Belmullet. A permanent centre home was considered in the longer term.
The Erris project, like many other teams of the ten projects, has been dogged by delays, underfunding and controversy. There were problems in recruiting key staff. There were difficulties getting funds to recruit staff but finding staff to work in remote north Mayo remains a persistent difficulty.
There have also been tensions between management and the health workers on the ground. Doubts over who was is ultimately responsible for running the services and deciding what services get funding remain.
There have also been problems beyond the control of those involved. The Government commitment has been inconsistent and funding has been slow. Only recently, with the appointment of Prof Brendan Drumm as HSE chief executive, has fresh impetus been given to the projects. Industrial relations problems between GPs and the Government have also held projects back.
As result of this myriad of issues, the Erris project has yet achieve its potential. On the plus side a physiotherapist and dietician have been recruited. Additional public health nurses and home helps have also been hired. A HSE report said the team played an integral part in the provision of services and support to the communities affected from the landslide in the area in September 2003. Among the other services added were chiropody sessions and osteoporosis scanning services.
On the downside the complement of four full time GPs has been halved and a sizeable number of patients depend on two locum doctors - one from South Africa and another from Hungary. The remaining full time doctors do not know when full time replacements will be found. It has also emerged that the project no longer has a dedicated manager.
Belmullet GP, Dr Michael Molloy has been with the project since the start. He believes that there has been some success and the addition of extra staff has improved services. However at the coal face he says he is overloaded with patients. He has more than 2,000 patients on his books of which 1,800 have medical cards. The patients are spread across a 500 sq mile area.
He employs one doctor, three secretaries and two nurses to cope but says all the staff are stretched to their limits. Dr Molloy regularly works until the early hours of the morning to keep his practice going.
Apart from their own patients the GPs provide services to Belmullet Community Hospital and a new nursing home in Belmullet. He is reluctant to criticise the health service or the project, but wants the doctor shortage to be addressed.
“It is very busy and we are undermanned. There are two doctors that are just temporary and by anybody’s standards, four doctors in an area this size is ‘underdoctored’,” he says.
A spokesperson for the HSE confirmed that there are two temporary GPs but she could not say when full time replacements could be found. The spokesperson said plans are in place for a building to house the Erris project. She said HSE engineers will have completed detailed plans for primary care centre within a month. She said an application has been made for funding to build a new centre. However this could lead to further tensions as support for the centre among the doctors is not unanimous.
The HSE could not provide any management who are directly involved in the Erris project to speak on the future direction of the service or the progress made to date. In the most recent national wage agreement, the Government made a commitment to set up hundreds of primary care projects. Some are likely to be set up in other parts of Mayo but the patchy and low profile development of the Erris model demands that health management prove that full support and funding is pumped in before expanding something which has huge potential for community health.