Primary Care During Covid 19

Will the Covid-19 pandemic result in a rapid reformation of primary healthcare in Ireland? World-wide, healthcare systems strain to meet the onslaught of demands created by Covid-19. Ireland, who was functioning near full-capacity prior to the pandemic, may have felt the overwhelm more keenly than their European neighbors.

Ireland’s healthcare system is regulated by the Health, Safety & Environment (HSE) agency. The current healthcare system has two sectors, a public sector and a private sector.

Public healthcare is funded by taxpayers and is granted to those who qualify for a Medical Card. The private sector is funded by individuals and companies and is somewhat costlier than public services, but it offers higher quality facilities and faster services.

Within public and private healthcare, primary care in Ireland includes all of the health and social care services within a community, outside of hospital services. The goal of primary care is to place the majority of care and rehabilitation within the community, saving hospital admittance for acute healthcare needs. However, primary care funding and staffing resources were too limited to adequately meet this goal, resulting in hospital overcrowding before the pandemic even hit Ireland.

With the onset of Covid-19 primary care providers and facilities were inundated, resulting in a significant interruption of all healthcare services. To address the sudden influx of Covid-19 related patient care, private healthcare facilities opened their doors to public healthcare patients, creating Public Private Partnerships that can focus on the health and safety of everyone.

The challenges faced at the beginning of Covid-19 caused HSE to re-evaluate their healthcare system and call for a major reorganization of the current infrastructure. With the development of new patient pathways and disease management protocol, along with a national campaign to recruit medical staff, including general practitioners (GPs), triage nurses, urgent care practitioners, midwives, senior care specialists, and other healthcare related employees, Ireland will experience an incredible improvement in healthcare accessibility.

Healthcare Flaws Exposed During Covid-19

The Covid-19 pandemic exposed areas of weakness in Ireland’s healthcare system. The lack of allocated support to primary care practitioners and facilities created a hospital-centric healthcare infrastructure. Having the lowest bed per 100,000 people ratio in Europe pre-pandemic [1], the hospitals in Ireland were already at or over 100% capacity, creating an overflow of patients waiting for care and a surplus of emergency services being provided by overburdened primary care facilities.

Why does Ireland have such a high hospital occupancy rate? According to reports from the Organization for Economic Co-operation and Development (OECD) and the European Observatory on health Systems and Policies [2], Ireland’s failure to invest in primary care and step-down care services increased the development of acute health conditions and lengthened hospital stays from lack of outpatient care options.

The need for nursing home care for the elderly, rehabilitation care facilities for post-hospital care, greater community outreach services, and a significant increase in permanent and temporary healthcare staffing became abundantly obvious during the ongoing Covid-19 crisis.

Responding to Covid-19

In response to the rapid surge in Covid-19 related screening, testing, and intensive care, Ireland quickly regrouped and is laying the groundwork for more efficient patient pathways to preventative, chronic, and acute care needs.

The hospital reorganized patient flow into a Covid-19 related pathway and a non-Covid-19 related pathway to slow the spread among patients and healthcare workers. They established testing hubs within communities to curtail the influx of hospital visits and to keep people close to their homes.

Primary care GPs and nurses were pulled from routine care practices to triage the flood of Covid-19 patients. They then set up field hospitals to treat the overflow of non-critical hospitalized patients, which was effective in mitigating the spread of the virus and addressing extended treatment wait-time for patients.

However, by pulling primary care medical staff away from their regular posts, in-home, and clinical primary care services have reduced by 43% [3]. As such, routine and preventative healthcare is decreasing while more acute needs in non-Covid 19 patients are increasing, adding to hospital admittance rates.

Moving Forward After Initial Covid-19 Surge

After lessons learned through the onset of the Covid-19 crisis, HSE recommitted to the goal of creating more effective patient pathways by developing the infrastructure that will divert preventative, chronic, and moderate-needs healthcare to primary care providers, in-home outreach teams, and specialized care teams. This is meant to reduce the number of patients needing acute hospital care.

The second piece of the healthcare improvement strategy is to increase post-hospital care options that will reduce the length of hospital stays while ensuring safe out-patient rehabilitation and care. The intended outcome of these strategies should decrease the demand for emergency services, thus avoiding the overcrowding of hospitals in the case of a second Covid-19 surge.

As part of the improved infrastructure, there is now a separate process for patients who are symptomatic of Covid-19 and Influenza. They will be directed to a community hub for screening and testing.

GPs and family healthcare nurses at the hub can then make the determination of the next steps, such as self-isolation or further medical treatment. Non-critical medical treatment will occur in the temporary field hospitals, while critical medical treatment will be administered in hospital.

For non-Covid-19 related illnesses or healthcare needs, patients can contact the primary care GP within their community, where a triage nurse assess symptoms, directing patients to the appropriate next step. With the recent investment and advancement of technology in the public health sector, many consultations can be directed to virtual or telemedical appointments rather than in-person appointments, thus slowing the potential spread of Covid-19 between patients and healthcare workers.

Now that the initial surge has declined, and the general population are learning more about effective safety precautions, there is a rise in patients seeking to reestablish their routine healthcare services. Reintroducing general medical services has been occurring in phases. The first phase is assessing the priority needs of more vulnerable populations.

One such population is the elderly. Because there are not enough nursing homes for older people, HSE is creating outreach services that would increase in-home services for home-bound or higher risk people, including administering Influenza vaccines to this susceptible population.

The next phase would include home visits or virtual or telemedical consultations for the back log of patients who are less critical but still in need of ongoing disease management, vaccinations, and referrals for specialized services or secondary care, as necessary.

The next step to reintroducing generalized medical care is to reimplement mental health services, preventative care, and routine services for all patients. This is thought to be accomplished primarily through virtual or telemedical platforms, or through non-Covid-19 community pathways. In addition, greater wide-spread vaccination programs are being developed in hopes of preventing more serious illness that might require acute emergency services.

How Ireland Will Support the Increase of Healthcare

With tourism significantly diminished, the decrease of national income and increase of national healthcare costs have hit Ireland’s economy particularly hard. With emergency legislation, the Public Private Partnerships, and the coming together of over 1,500 client companies, the Irish government is witnessing a cohesiveness national effort in emphasizing the continuity of quality healthcare and public health safety [4].

In order to implement and sustain the phases of reestablishing generalized primary care and maintaining safe patient pathways in the case of a subsequent surge of Covid-19 cases, more healthcare staff is imperative. The “Be on call for Ireland” campaign has attracted over 70,000 volunteers in the case of a second surge, but permanent GPs, nurses, and trained healthcare workers are desperately needed.

To ensure support and success in meeting the vast healthcare needs in the wake of the pandemic, healthcare jobs across Ireland are in abundance. Triage nurse jobs are available for determining initial patient needs, processing screenings and tests for Covid-19 among the population and healthcare workers. GP jobs and nurse jobs are available for the mobilization of specialized care units for seniors, the disabled, and other vulnerable populations who are at high risk for contracting Covid-19.

Urgent care positions and out-of-hours GP and staff nurse jobs are abundant in the community hubs as well as in clinical settings. Urgent care positions and out-of-hours GP and nurse jobs are open. Temporary Locum GP and nurse jobs are available to fill in for healthcare workers who become ill and need to quarantine. Corporate health jobs and student health jobs are being created to keep communities safely localized. This includes rural GPs, nurses, and midwives as well.

Join Us as We Advance Primary Care in Ireland

Ireland is already renowned for well-trained medical doctors, nurses, and healthcare staff. We greatly value continued professional development and technological and medical advancement. Come join our community of medical professionals as we make unprecedented strides in primary care and Covid-19 treatment. Relocating to beautiful, historically-rich Ireland is a dream for many, but you can make it a reality. For more information on what primary care in Ireland has to offer in terms of advancement and jobs, be sure to visit our full job list.

Additional Resources:

[1] https://www.noca.ie/documents/irish-national-icu-audit-annual-report-2018

[2] https://read.oecd-ilibrary.org/social-issues-migration-health/ireland-country-health-profile-2019_2393fd0a-en#page1

[3] https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/service-continuity-in-a-covid-environment-a-strategic-framework-for-delivery1.pdf

[4] https://www.eversheds-sutherland.com/global/en/what/publications/shownews.page?News=en/ireland/covid-19-emergency-irish-health-sector-response-ireland

https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/oncall/