The role and function of Primary Care Teams in Ireland

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The role and function of Primary Care Teams in Ireland.

1. " What are Primary Care Teams?"

Primary Care Teams (PCT) are teams of healthcare professionals who work closely together in the community to treat patients away from a hospital setting. A PCT consists of all or a selection of the following :

• GP and Nurse
• Physiotherapist
• Public Health Nurse
• Occupational Therapist
• Psychologist
• Dentist
• Social Workers
• Home Care Specialists
• Dieticians
• Speech and Language Therapists
• Ophthalmologists and ENT Specialist

Other more alternative services such as a podiatrist, a chiropodist, Acupuncturists etc may also be present.
The PCT most often consists of a GP, a Nurse and a Physiotherapist while many of the other professions split their time between two or more teams. This is be very common with Occupational Therapists in particular.
Primary Care Teams should ideally be housed within the same complex where they could easily refer to and consult on different cases, this however appears to be more difficult than first imagined as many Physiotherapists who work in the community find themselves working alone and sometimes without an office/base for their practice. 

The HSE, which is the driving force behind this initiative hopes that PCTs will ultimately care for the rehabilitation of patients within the community following a hospital visit saving them from returning to hospital on a regular basis for after-care. The HSE currently has 222 active PCT around the country, though it is hard to know which of these are working at maximum efficiency as it appears that some do not have a base/centre to work out of. There are plans to have 530 teams formed by 2011.

Having spoken to a number of Physiotherapists who work in a Primary setting I feel that PCTs could potentially be very beneficial. A problem with the system as it is now is that there is very little consistency. In a PCT all professionals have access to the patient’s history and could potentially make a more accurate, team-based diagnosis and management plan.
For a PCT to function at this ideal capacity it must be laid out correctly in one centre or complex where there are one set of patient notes. Currently there appear to be many PCTs which do not have this facility and therefore are forced to function as individual GPs and Physiotherapists working alone in a primary setting. Though they might refer to each other they do not function as a single team.

2. Profile of a Primary Care Physiotherapist

As the aim of Primary Care Teams is to treat more patients in the community and to direct the non-acute cases away from hospitals, a lot of physiotherapists are moving out of hospitals and into community settings. This is the profile of one Primary Care Physiotherapist who moved from working in an out-patient department of a regional hospital and into a community hospital.

Grade: staff grade

Patients: treats musculoskeletal outpatients and under 65s with disabilities.

Most common conditions treated: treats mostly musculoskeletal problems such as back and neck pain. Also treats patients under 65 with disabling conditions such as MS and Motor Neuron Disease.

Patients referred by: GPs, Public Health Nurses and Consultants. Patients cannot self-refer. Patients who have had surgery in private hospitals often ring up to make an appointment as they have been given exercises to do at home but have not been referred to any physiotherapist. In these cases, the patients are told to go to their GP. The GP will then refer them to the physiotherapist and pass on the patient history.

Interactions with other health care professionals: Communicates with Occupational therapists, GPs and public health nurses when needed.

Where patients are treated: treats most patients in the community hospital physiotherapy department where they are bases. Patients treated in homes very rarely.

How workload is structured on a daily basis: tries to treat 2/3 new outpatient referrals a day and 6/7 review slots. It is the aim to leave one afternoon a week free for treatment of disability patients.

Working hours per week: works 9 - 4.30 Monday to Friday.

On call situation: not ever on call at the moment but will be.

Difficulties working as a physiotherapist in the community:
• Staff not as accessible as in hospitals and continuous professional development is difficult.
• Referrals go missing
• Had 9 DNAs in 22 treatment days in the last month. Patients are more likely to attend private physiotherapy appointments as they are paying for them.

Benefits of treating patients in the community (physiotherapist’s opinion):
• Having Occupational therapists which are treating your patients nearby.
• Having your patients GPs nearby if you need to refer.
• Having more time with your patients.
• The environment is not as intense as in hospitals.

Waiting list at the moment:
Patients are prioritised in order of their urgency to be treated. Patients prioritised as having P1 conditions are treated as soon as possible. These conditions include:
All paediatric conditions, acute neurological conditions, fractures, falls of the elderly. At the moment 80% of referrals are seen within 8 weeks and all referrals are seen within 12 weeks.

3. How patients are transferred from acute care to primary care?