College Health Service

Annual Report 2012

The mission statement of the College Health Centre

adopted by Board (June, 1999)

“The mission of the College Health Service is to provide ambulatory health care for the College Community, to promote health education within the College and in so doing, encourage healthier life styles and a safe working environment for both staff and the student body.”

This report covers the calendar year 2012аnd is an assessment of the current situation at the College Health Service.It highlights current activities and trends at the College Health Service and also reflects areas for concern at present and in the short term.

The team comprises General Practitioners, Nurses, a Psychiatrist, a Physiotherapist and an Administrative unit.

Student consultations are free of charge with modest charges for additional services.

Staff consultations attract a fee per visit to the service.

The service is funded through a combination of Cista Communis contribution and locally generated income.

Medical / Clinical Services

Activity

We continue our policy of providing an ambulatory health care service available to all undergraduate and postgraduate students on campus, Monday to Friday, 9.00am to 5.00pm. The basic consultation is free of charge, but modest charges are imposed for vaccinations, laboratory tests, physiotherapy and medical examinations for insurance companies and external employers. In term time we endeavour to have at least three GPs consulting each morning and at least two each afternoon. Even with this level of service, such has been the demand, that the average waiting time for routine appointments through the past year was in excess of one week.

In addition to booked appointments we also provide a "sit and wait" emergency service each morning and afternoon. Prior to this year only a small number of patients could be seen in each of these sessions. This year however we have allocated a GP for ninety minutes each morning and the entirety of each afternoon to manage walk-in patients and this has been reflected in a significant increase in the number of walk-in patients seen each day.

By taking this GP away from routine appointments each afternoon, however, the waiting time for routine appointments has increased but at least we are in a position to provide a same day service for urgent cases.

Closely allied to these clinics are the booked nursing clinics which run all day, and the very effective triage system, whereby a nurse can make an assessment of the severity of the student`s illness and prioritise their care in the "sit and wait" surgery

In addition to our core service to the Student Body we provide

 Seven consultant psychiatric sessions per week for students with moderate to severe mental health problems. These students are referred from the College Health Service GPs, Counselling Service, Disability Service or occasionally from external Psychiatrists. Registered students are assessed and treated by the College Psychiatristfree of charge.

 Twenty four hour cover through Mediserve Homecare Ltd and DUBDOC, an out of hours service based in St. James Hospital. This involves my participation in the DUBDOC roster at weekends, bank holidays, and evening sessions in St. James’ Hospital on average two sessions per month.Physiotherapy clinics, two sessions daily, Monday to Friday for staff and students from September to June, at a cost of €20 for students and €40 for staff.

 Twice weekly Sexual Health Clinics in association with St. James’ Hospital, Genito-Urinary and Infectious Diseases Department, attendance fee €15.00 in lieu of specimen transport costs and €20.00 deposit to discourage non attendance.

 Nurse led contraceptive advice, smears and Chlamydia screening.

 Staff GP sessions daily, attendance fee €45

 Travel Health and Vaccination for Staff and Students, at highly competitive rates. There has been a dramatic fall in the demand for Travel Vaccination due to the downturn in the economy.

 We work closely with the Medical and Dental schools to provide travel medicine advice to those students travelling abroad for their electives and we run specific Travel Health and vaccination clinics for these groups.

 Hepatitis B vaccination clinics for Health Science students, and for Clinical, Academic and Service Staff inat risk occupations.

Staffing plan

Staffing levels and funding sources

3.4 Full time equivalent GPs

2 Full time equivalent nurses

2.4 Full time equivalent administrative officers

7 Consultant Psychiatric sessions October to June reduced over summer period.

9 SessionsPhysiotherapist October to June

Resourcing of Staff

Combination of Cista Communis and Non Pay Budget

CistaNon Pay

Director GP DMG(1fte)2 GPs CH /AW (1.4)

Assistant Director NF (0.7fte)1 Nurse CL (1)

2 GP`s NM /MS (1fte)Physiotherapist (0.7)

2 Nurses CC / AF (1fte)Health Promotion (0.2)

2 Senior EO`s AW /EH (1.8fte)Receptionist (0.6 )

Budgeting

Previously Budget allocated annually

Non Pay Budget balance annually

Difficulties from 2009

Increased student numbers

Increased diversity

Increased Fixed costs,

93% of non-pay budget is staff costs.

40% increase in Medical indemnity fees in 4 years

10% increase in Drugs / Dressings pa

allied to

Central reduction in GMS fees

Reduction Discretionary spend, Travel, Regular check-ups

Use of College Health Service by Demographics

Irish Male 18yo UG1.0

Irish Female 18yo UG1.7

All Post Grad2.5

International Post Grad4.5

In previous Annual Reports, I have outlined in detail the implications of the lack of space for service development within the College Health Service. It was clear that it was not physically possible to put more patients through the system due to the structure of the premises and its inability to cope with the current student body of over 16,000. This year, there has been a reduction in the usual throughput in the Nursing Department. This was as a direct affect of the Croke Park agreement where one of our nurses was not replaced during a period of sick leave.

This year there was an increase in the number of pre-employment medicals carried out on behalf of the College but this was significantly lower than the norm as a direct result of the recruitment embargo in the public sector, which came into effect on 1st April 2009.

The number of face to face consultations with the College Psychiatrist increased in 2011 by 26% on the previous year. This year the increased figure has been maintained.

A new initiative, focusing on the needs of those students with Aspergers and ADHD which was piloted in 2010, has been maintained by the College Psychiatrist who supervises two Senior Registrars in Psychiatrywho are carrying out research in this area.

Substantial need had been identified in this area and we are grateful to the College for providing the extra resource to cater for this demand.

Demand for the Sexual HealthClinic is continuing and having experienced a 20% increase from 2010 to 2011 the demand remained much the same this year. In addition the waiting time for the Sexual Health Clinic increased and that is an area that we will hope to address in the next session.

One area where a significant reduction in demand was seen was the area of travel vaccinations and immunisations. This is a clear barometer for the economic status within the country as a whole. It also reflects the huge increase in travel vaccines and travel clinic appointments provided in the preceding five years which meant that the majority of non first year students had already been vaccinated and most of these vaccines have a three to ten year cycle. This drop in demand for travel vaccines will inform our decision on clinic allocations for 2013 and it is highly likely that this will enable us to reduce the travel clinic provision and increase the level of general appointments.

Total attendance has remained static although demand has increased. Effectively, with premises which were developed for a college population of no more than 10,000 students and staff combined, the service is bursting at the seams. Various factors contribute:patient satisfaction with service, increased expectations, crises in accident and emergency and the cost of surrounding GP services for the overwhelming number of students that do not qualify for medical cards.

The increased demand for a finite resource has led to significant waiting times for routine appointments. The average waiting time to see a GP in 2012 was 7.5 days, an increase from 4 days the previous year and was as high as 20 days at peak times of the Academic year

There were 12,425face-to-face Consultations with students. Of these, almost 30% were emergency or “sit and wait” consultations.

The increase in this area reflected the allocation of a GP specifically for the ‘sit and wait’ category each afternoon. This has allowed us to respond rapidly to the need for same day consultations.

The number of consultations per GP per three hour session averaged 17 in term time, reducing to 15 in the summer. This should be seen in line with the recommendationof 15 minutes per consultationofthe Royal College of General Practitioners i.e. 12 consultations per 3 hour session.

Trends in Workload

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2011 / 2012
GP Student
GP Telephone / 12,283
3,925 / 12,425
4,174
Nurse consultations / 8438 / 8,062
Psychiatric consultations / 1,044 / 1,018
Physiotherapy / 1,442 / 1,471
Pre Emp Medicals* / 239 / 414
Sexual Health clinic / 581 / 576
Staff clinics* / 1214 / 1,239
Hepatitis B / 1815 / 1,300
TOTAL / 30,981 / 30,679

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Additional Duties of the Director
In addition to routine clinical duties, the Director is also involved in several Administrative and Teaching roles throughout the College.
Examples are: -

Member of the Heads Forum
Member of the Senior Administrative Management Team
Member short term Fitness to Practice Working Group
Liaison with Senior Lecturer’s Area to assess Absences and Re-admissions to College on Medical Grounds via the Dean's consultation Group
Assessments of Fitness to Practice Issues for Students on Professional Courses
Allocation of Student Accommodation on medical grounds
Providing medical opinions to The Junior Dean, The Warden of Trinity Hall and the Tutorial Service
Chair of the College Health Week Committee
Member of the Radiation Safety Committee of the Dental Hospital

Member of the College Administrative Services Safety Committee
Member of the College Safety Committee
Lectures to Junior Freshman Medical Year as part of the Psychiatry Course.
Coordinates the Medical and Dental Electives and RussianDepartmentTravel Medicine requirements
Assesses all new Pre-Employment Medicals for College in association with the Staff Office.
External to the College, the Director is involved as Joint Course Director in Minor Surgery for GPs with the Irish College of General Practitioners (ICGP)

Review of Planned Clinical Developments for 2012

In my last Annual ReportI identified two clinical issues which we would aim to develop in 2012.Each were in the area of psychiatry. We were successful in launching a service for students with Eating Disorders with clinical input from the College psychiatrist, two GPs, a student health nurse and a counsellor from the Student Counselling Service. This service has now facilitated several groups of students through the six week programme. The service has involved very close co-operation between the College Health and Student Counselling Services and to date the feed back has been very positive particularly for those students suffering from Bulimia Nervosa.

Some minor changes to the programme which involves different modules focusing on all aspects of the physical and psychological issues related to eating disorders have been made. Our close working relationship with the Student Counselling Service is a significant advantage to this group of students who can also avail of the expert Internal and External Groups running on campus related to Eating Disorders.

In addition, the Service was involved as the control arm of a large research project led by the Department of Psychiatry at Beaumont Hospital, looking at disordered eating patterns in young people. A much higher level of eating disorders of all types was identified and we are grateful to those students who participated in the study and who gave us permission to contact them. This group will be the focus of our Eating Disorder Strategy for 2013.

The findings were presented at the Annual Scientific Meeting of the Irish College of Psychiatry and at the Irish Student Health Conference in UCD in March and have now been submitted for publication.

The second projected clinical development was a spin off of the Alcohol management programme initiated in 2011and funded with the assistance of the Office of the Junior Dean and has been co-ordinated by Mr. Rolande Anderson from the ICGP in conjunction with Dr. Farrelly and Dr. McGrath. Several workshops have taken place in which those students who have been identified with alcohol problems have been invited to attend and again the feedback from this resource has been excellent.In addition, we have taken on the practice of out patient detoxification and management of patients with severe alcohol problems. Clare Lynch, Nurse and Dr Farrelly have supervised a number of such cases this year and we hope to meet the demand for this Service in 2013.

In addition the director, in association with the IUSSN and his counterpart in UCC, met with Minister Shorthall at her request, to represent the views of the College Health providers around the country in relation to the drive to reduce the consumption of alcohol and thereby reduce the Health and Social implications of alcohol misuse. This is an ongoing project and will be a focus for next year.

Dr Farrelly, in association with the Child and Adolescent Psychiatry Unit atTallaght Hospital, is supervising a Specialist Registrarto run an in house Assessment for Adult Attention and Hyperactivity Disorder. This service augments the work of the Disability Service through Unilink and is a major additional cost neutral resource for 2013

Review of Planned Non-Clinical Developments 2012

Non-Clinical developments focused in the main on planning for the proposed move of the College Health Service to the new Student Centre, which was to be based at Luce Hall. Unfortunately, the referendum on this issue was not approved by the student body. The need for additional space is more pressing with each increase in student numbers and the procurement of adequate premises remains a priority for the service

The existing Computer System, Dynamic, had been in place for several years and was upgraded by Helix Health in late 2011. A major difficulty with the system made it impossible to generate accurate reports for almost a year. Our colleagues in IS Services have approved the systems reporting system. We are most grateful to ISS for providing us with the technical expertise in liaising with Helix Health and despite significant teething problemswe expect that the system will prove very helpful in both the management of the Clinical and non Clinical systems within the College Health Service.

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Current Areas of Concern

Premises

The single overwhelming issue currently affecting the Health Service is one of Clinical space. We have developed an excellent multidisciplinary team that unfortunately is severely constrained by a building that is no longer fit for purpose.

A great advance at the time of its development, the current building was designed for a situation where the student and staff numbers would never exceed a combined 10,000.

The figure for the academic year under review is 16,747students and 2,839 staff, a total of 19,586 and this is likely to be increased by a further 5% in 2013

Any further growth in student numbers will compromise our ability to provide safe, quality health care provision for students. We mayalso have difficulty in fulfilling our obligations to the Health Authority under the General Medical Services scheme.

Trinity has always led the way for other Irish Universities in terms of Health Provision for students, but we are now significantly lagging behind our counterparts, in particular UCD, UCC and NUIG on the issue of premises. The Trinity Experience promises a holistic supportive College environment and a modern College Health Service is a crucial element in facilitating the journey of the student on his or her academic path.

In addition, the demographics of the student body is changing and with the current drive for increased numbers of International and Post–Graduate Students, there will be increased demands on the service, as each of these groups require significantly more medical and psychiatric support.

Additional space would not alone allow for greater service provision for students, it would also create the possibility of greater income generation by the service, which may offset much of the running costs of new premises.

In the context of the proposed development of a new Student Centre at Luce Hall,I supplied the Director of Buildings’ Office with a template and floor plan for a new Health Centre. As the current Health Centre was built at little cost to College following a wonderful gesture from the Buckley foundation, it is to be hoped that College would see fit to provide the service with a modern purpose built premises, should it be deemed necessary to demolish the current Buckley Foundation funded premises. The fact that the original plan for Luce Hall, including bars and a gig venue, was not approved may inform the Planning Committee of the need for a Student Experience / Welfare focus to the building with allocation of space to cognate services.