Minister for Health announces huge increase in use of GP access to Community Diagnostics Scheme

• over 700,000 diagnostic scans completed since scheme was introduced in January 2021 – at no cost to patients
• hundreds of thousands of outpatient appointments avoided through community diagnostics scheme
• funding allocated in 2023 totalled €46.8 million

Minister for Health Stephen Donnelly has today revealed that over 700,000 directly referred community radiology diagnostic scans have been completed since the launch of the General Practitioner Access to Community Diagnostics (GPACD) Scheme.

Demand for community radiology diagnostics delivered through the scheme has more than doubled since it launched in 2021.

There were 138,000 radiology scans were undertaken in 2021 (vs. target of 94,000); 250,000 in 2022 (vs. target 195,000); and over 331,000 (vs. target 240,000) in 2023. The budget for the GPACD scheme has increased from €25 million in 2021 to €46.8 million in 2023, with the substantial investment to date being maintained in Budget 2024, with a total allocation of €47.9 million secured for continued provision of the scheme this year.

The Minister launched the scheme in January 2021 to enable easier GP and patient access to a suite of radiology scans. Under the scheme, GPs can refer patients directly for tests including X-ray, dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI) at no cost to the patient, with access to the scheme available to the full adult population.

Patients attend convenient locations in the community setting to access these radiology diagnostics at facilities located across the county and with nationwide coverage provided. Studies have shown that a majority of patients are being seen within a month for scans under the initiative. Up until the launch of the scheme, patients had to be referred on to an outpatient appointment with a hospital consultant before accessing these radiology scans or to pay privately.

The scheme delivers greater levels of care in the community setting, in line the Sláíntecare objective of providing the Right Care, in the Right Place, and at the Right Time.

Minister Donnelly said:

The GPACD Scheme is available nationally for all GPs.

Dr Diarmuid Quinlan, Medical Director of the Irish College of General Practitioners (ICGP), said:

This scheme is particularly welcome for public patients without the means to pay for health insurance or private scans. Before the initiative was launched, these patients had to first be seen in an outpatient clinic before a scan could be booked. Timelier access to diagnostic scans for certain conditions has enormous benefits for patients. While not workload-neutral for general practice, GPs report this scheme improves patient care in more than 90% of cases and thus engagement with the scheme from general practice has been very strong.

This structured pathway for GPs to directly access diagnostic tests enables a greater level of care to be delivered in the community, supporting early diagnosis, and early intervention. Limited access to diagnostics can result in patients being referred to hospital Emergency and Outpatient Departments for services.

Since its commencement in January 2021, GPs have increased direct access to community radiology diagnostics scans for their patients, with referrals being open to the full adult population (since May 2021).

The referral pathway facilitates GPs to directly refer patients to a suite of X-ray, dual-energy X-ray absorptiometry (DXA), computed tomography (CT), and magnetic resonance imaging (MRI) studies at no cost to the patient.

Providers of these facilities are:Affidea, Alliance Medical, Bon Secours (Tralee), Medica, Complete DXA Solutions, Beaumont Private and UPMC Whitfield.

A list of services is available.

As the suite of radiology diagnostics provided is designed to maximise GPs' ability to treat patients in primary care, the initiative demonstrates the ‘home first’ approach that is a key focus of our health and social care reform.

Studies (see [1] and [2] below) from ICGP and University College Dublin (UCD) show four major themes identified by GPs with respect to the scheme:

• improved patient care (in 9 out of 10 cases)
• increased GP workload (in 6 out of 10 cases)
• a reduction in hospital referrals for problems requiring imaging (of more than 50%)
• opinions on ongoing management of such initiatives

GPs are predominantly using the scheme for MRI scans, which account for almost two thirds of scans organised via the scheme [2]. MRIs of the spine, lower limbs and brain are the three most common MRI scans organised. Results from these studies help GPs and their patients determine appropriate next steps regarding management.

Studies show that due to timely access to scans through the scheme, the care of many of these patients is remaining with their GP [1,2]. Indeed, more than 50% of patients that would have needed an outpatient appointment to organise a scan prior to the initiative did not end up requiring an outpatient referral once the scan was possible via this scheme [1,2]. For the patients who did require referral to see a hospital-based consultant based on their clinical case and the scan findings, it is important to remember that they now have a scan already completed, which will help speed up their management in the public system.

Information from two recent research studies organised via UCD and the ICGP indicate that more than half of the scans being organised via the scheme are completed within one month of the GP referral.

Papers cited above

[1] O’Callaghan, M.E., Fawsitt, R., Gao, J. et al. Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study. Ir J Med Sci (2023).

https://doi.org/10.1007/s11845-023-03419-1

[2] O’Callaghan ME, Fawsitt R, Cullen et al. HSE Enhanced GP Access to Diagnostics Initiative - National Project Report – AWAITING PUBLICATION