GP diagnostics

Schemes and Eligibility

GP Access to Community Diagnostics is integral to the Enhanced Community Care programme and in line with the Chronic Disease Management Programme and GP Agreement 2019.

Imaging

• GP Access to Community X-Ray, CT, MRI, and DXA is available to the full adult patient (16 years of age and over) population of Ireland via private providers (Affidea, Alliance Medical, Bon Secours (Tralee), Medica, Mobile Medical, Complete DXA Solutions, Beaumont Private and UPMC Whitfield)
• GP access to Community Ultrasound is available to adult patients (16 years of age and over) with a medical card, GP visit card, or Health Amendment Act (HAA) card via private providers (Scan Clinic, Medica, Alliance Medical, Affidea, Bon Secours (Tralee), and Beaumont Private).

Both schemes aim to support early diagnosis of disease, improve patient experience, and reduce hospital referrals.

Please see below and GP Access to Community Diagnostics and Community Ultrasound FAQs file for a list of all scans available on the scheme. Not all scans are covered on this scheme, so please read below to ensure the exam is covered; otherwise, you should refer via the traditional channels.

GP Access to Community Diagnostics and Community Ultrasound FAQs (PDF, size 430 KB, 12 pages)

MRI

Brain - MRI Brain, MRI Brain and IAM’s, MRI IAM’s, MRI Pituitary Contrast

Spine - MRI Cervical Spine to include cervicothoracic MRI Thoracic Spine to include thoracolumbar, MRI Lumbar Spine, MRI Lumbosacral Spine, MRI SIJ’s

Pelvis and Hips - MRI Bony Pelvis, MRI Pelvis and Hips, MRI Hip

Extremities - MRI Knee, MRI Shoulder.

*Excludes MRI Pelvis Gynae

CT

Brain/Sinus/Neck - CT Brain, CT Brain and Sinus, CT Sinus, CT Neck

Spine - CT Cervical Spine, CT Lumbar Spine

Thorax/Abdomen/Pelvis - CT Neck and Thorax, CT Thorax, CT Thorax HRCT, CT Thorax and Abdomen, CT Abdomen and Pelvis, CT Abdomen (Liver, Pancreas), CT KUB or Renal,

DXA

Bone Densitometry

X-ray

Head/Neck - XR Facial Bones, XR IOFB, XR Sinus, XR Soft Tissue Neck

Spine - XR Cervical Spine, XR Thoracic Spine, XR Lumbar Spine, XR SIJ

Chest and Abdomen - XR Chest/lateral, XR Sternum, XR Abdomen, XR KUB

Pelvis and Hips - XR Pelvis/Hips, XR Pelvis, XR Hip

Upper Extremities - XR Shoulder, XR Clavicle, XR AC joint, XR Humerus, XR Elbow, XR Radius and Ulna, XR Wrist, XR Hand, XR Fingers, XR Thumb, XR Scaphoid

Lower Extremities: XR Femur, XR Knee, XR Patella, XR Tib/Fib, XR Ankle, XR Calcaneum, XR Foot, XR Toes

Ultrasound

Neck - US Neck/Thyroid

Abdomen and Pelvis - US Abdo Pelvis, US Abdomen, US Abdo Renal, US Renal US Pelvis, US TV, US Pelvis and TV

Other - US Testes, US Soft Tissue, US Groin

Are clinical guidelines available to support my decision when referring a patient?

For imaging, the ICGP has developed a Quick Reference Guide (QRG) for GPs in practice that focuses on the use of various imaging modalities for various clinical issues. QRGs offer GPs a trusted information source that can aid the delivery of timely, evidence-based care to patients. The new QRG (based on the iRefer guidelines) is available to ICGP members via the ICGP website and aims to assist GPs in rationalising imaging studies for the various clinical issues encountered regularly in daytime general practice.

GPs also have access to the iRefer Guidelines, please contact community.diagnostics@hse.ie for info on how to access iRefer.

Where to refer for imaging

Private Providers are delivering services across the HSE Health Regions.

The Health Region matrices (see related files below) provide detailed information on locations to refer your patients. You can refer your patients to any location regardless of the Health Region your practice is located in.

GP Access MRI Xray CT DXA US - Dublin and Midlands (PDF, 564 KB, 16 pages)

GP Access MRI Xray CT DXA US - Dublin and North East (PDF, 564 KB, 15 pages)

GP Access MRI Xray CT DXA US - HSE Dublin and South East (PDF, 574 KB, 15 pages)

GP Access MRI Xray CT DXA US - Mid West (PDF, 349 KB, 9 pages)

GP Access MRI Xray CT DXA US - South West (PDF, 566 KB, 14 pages)

GP Access MRI Xray CT DXA US - West and North West (PDF, 390 KB, 11 pages)

Note: You will also find information on local initiatives in grey. You should contact the local area if you require information regarding these local initiatives to confirm specific referral guidelines.

How to refer for imaging

You can refer to all private providers including Mobile Medical by submitting an e-referral using the General Referral Form on Healthlink. Healthlink is accessed via the Healthlink web portal or accredited practice management software.

Before referring a patient for a scan, you must:

1. Assess if the patient requires a scan.
2. Check if this service covers the patient and scan type.
3. Inform the patient of the private providers available.
4. Refer the patient via the appropriate channel (via this service or hospital or privately if not covered)

What information do I need to include on the referral for imaging?

Please complete all the required fields when filling out the General Referral Form via Healthlink (see below).

Information Required in General Referral Free Text Box

1. Code: *‘GP Access to Community Diagnostics’ - for example GP Access to Community Diagnostics or GPACD
2. For US, please note the *Medical card or GP visit card number, only for GP Access to Community US scheme (8 characters) - for example A1B23456C
3. Patient mobile number (if not provided already)
4. Part of the body to be scanned (depending on the type of scan being requested) - for example Sinuses
5. Clinical Indication - Always provide all relevant clinical reasoning for the request to ensure the exam is justified and can address the clinical query
6. Modality - consult iRefer or the QRG to select the most appropriate imaging modality based on specific clinical indications - for example CT
7. Be aware of any contraindications for specific imaging studies and note same on referral - for example Pregnancy, low GFR, claustrophobia, implantable cardiac devices, contract allergies
8. Urgent or Routine
9. Previous imaging - Please advise on relevant previous imaging completed and attach previous imaging report to the referral - for example MRI Brain at St James’ Hospital

*Required for invoicing

You can find further information in GP Access to Community Diagnostics and Community Ultrasound FAQs (PDF, size 352 KB, 12 pages).

Community Mobile X-ray

Mobile X-rays are now available for people in Nursing homes, community hospitals and transitional care units. In limited circumstances, mobile x-ray can be provided in the patient’s home and is subject to a risk assessment where it is restricted to individuals who are:

• Housebound and immobile or
• Present with significant behaviours of concern and where transfer to a hospital environment may create safety concerns for the person and staff

Mobile x-rays can be ordered by IMC registered GPs and are delivered by Mobile Medical Diagnostics. See contact details below:

Phone: 087 056 4412
Phone: 01 575 09908

Email: info@mobilemed.ie

Website: mobilemedicaldiagnostics.ie

Mobile X-rays in scope

• All general x-rays including CXR, abdomens, extremities, and spine

Mobile X-rays outside scope

• Skull x-rays
• If a patient has a recent trauma and has a spinal injury with a neural deficit, please refer to the nearest Emergency department

How to refer for a Community Mobile X-ray

You can refer to Mobile Medical Diagnostics by submitting an e-referral using the General Referral Form on Healthlink. You can also refer to Mobile Medical Diagnostics via Healthmail. A referrer must complete an order form (example included as appendix 3) and it must be sent via Healthmail to info@mobilemed.ie. If referring via Healthmail please include the following information:

Information Required in General Referral Free Text Box

1. Patient name
2. Date of birth
3. Nursing Home address or private dwelling address
4. Patient contact number or relative/carer contact number if private dwelling
5. Part of the body to be x-rayed
6. Clinical Indication - Always provide a relevant review of the patient’s clinical history to justify the exam - for example Fall
7. Query - for example Fracture, LRTI
8. Female - Last menstrual period (LMP) start date if applicable (12 to 55 years) - for example for examinations between the xiphoid sternum and symphysis pubis. e.g. Lumbar spine, pelvis
9. GP name, signature and IMC Number
10. GP Contact Details mobile for critical findings and email/Healthmail
11. Date of Referral

Echocardiography and Spirometry

Direct GP access to Echocardiography and Spirometry will enhance the diagnosis and management of individuals with heart failure, COPD, and Asthma. GPs will have direct access to Echocardiography and Spirometry nationally (on a phased basis) via public hospitals or your local Chronic Disease Community Specialist Team. The echocardiography and spirometry services are available to all adults (Patients aged 16 years and older) regardless of their GMS status (public or private patient). For more information, please see the FAQ documents below: Spirometry FAQ and Echo FAQ.

For patients already enrolled in the CDM programme, the GP Structured Chronic Disease Management software will prompt you when an Echocardiogram or Spirometry may be indicated.

For patients not enrolled on the programme, access to Echocardiography and Spirometry may be required for diagnostic purposes. Patients may subsequently be enrolled in the CDM programme. In these cases, the software prompt will not appear. To ensure the appropriate use of the test in these instances, please refer to the Echo and Spiro Flowchart and Echo and Spirometry Patient Information Leaflet.

Echo Flowchart (PDF, size 663 KB, 1 page)

Spiro Flowchart (PDF, size 640 KB, 1 page)

Echo Patient Information Leaflet (PDF, 444 KB, 2 pages)

Spirometry Patient Information Leaflet (PDF, 203 KB, 2 pages)

In addition, please consider whether the patient meets the referral criteria as set out in the FAQ documents Echo FAQ and Spiro FAQ.

Echo FAQs (PDF, size 868 KB, 6 pages)

Spiro FAQs (PDF, size 908 KB, 8 pages)

Where to refer for Echocardiography and Spirometry

GPs will be contacted by their CHO or nearest hospital providing the service to confirm the commencement of the service and provide instructions on how to access their local echocardiography and spirometry service.

How to refer for Echocardiography and Spirometry

Referrals will be made using the Standard Healthlink Referral form. Referral can be made by selecting “Card-Echo diagnostics” or “Resp-Spiro diagnostics”. You can find further information in the FAQ documents. For guidance on referral for Echocardiography and Spirometry, please see the Direct GP Access to Echocardiography and Spirometry Frequently Asked Questions documents:

Echo FAQs (PDF, size 868 KB, 6 pages)

Spiro FAQs (PDF, size 908 KB, 8 pages)

Printable poster - you can print the below poster and display in your GP surgery to support decision making:

Making best use of direct access echocardiography in the Chronic Disease Management Programme (PDF, 170 KB, 1 page)

NT-proBNP Testing

Direct GP access to NT-proBNP blood testing will enhance the diagnosis and management of individuals with Heart Failure, Atrial Fibrillation, Type 2 Diabetes, and Ischemic Heart Disease in Primary Care. NT-proBNP blood testing is available for the full adult population (patients aged 16 years and older) regardless of GMS status (public or private). The NT-proBNP test is an expensive laboratory test and should only be ordered in general practice in specific circumstances (see national referral criteria below). Please only order an NT-proBNP test for patients who fulfil one or more of these criteria to ensure that the capacity of the laboratories to deliver this service is not exceeded.

Clinical indications for referral for NTproBNP

1. Suspected new onset heart failure

• NT-proBNP<400 ng/L: HF unlikely. Consider other causes for symptoms.
• NT-proBNP>400 ng/L: Refer for Echocardiogram.
• NT-proBNP>2000 ng/L: Refer for urgent echocardiogram and specialist review.

2. Existing HF with suspected deterioration

Not for regular use with every deterioration of HF. Useful in existing HF with multi-morbidity (e.g. COPD) where symptoms of deterioration are similar (dyspnoea). A stable NT-proBNP suggests HF is not the cause of the deterioration. A rise of 30-50% suggests that HF is the cause of deterioration.

3. First registration visit related to the Chronic Disease Management programme

Raised NT-proBNP should firstly prompt a check for symptoms and signs of HF and appropriate management if present.

In the absence of clinical features of HF, an elevated NT-proBNP should highlight patients at higher cardiovascular risk and prompt us to achieve tighter control of risk factors and to “look under the bonnet” to see if there are any previously undiagnosed issues at play (ECG to look for AF, ABPM to assess BP control).

Where to refer?

GPs refer samples for NT proBNP test to their local hospital laboratories for testing.

How to refer?

Referrals should be made in line with the local protocols and processes in place in your local laboratory.

For additional information, please refer to the FAQ document, Guidelines for NT-proBNP Testing for GPs and Laboratories, and an At-a-Glance Summary of CDM Laboratory Tests:

GP Access to Diagnostics NT-proBNP FAQs (PDF, 355 KB, 8 pages)

NT-proBNP Advisory note for GPs and Laboratories (PDF, 125 KB, 4 pages)

At a Glance - Summary of CDM Laboratory Tests (PDF, 415 KB, 1 pages)

Should you have any questions or require further clarification on any of the schemes, please do not hesitate to contact the Community Diagnostics team via community.diagnostics@hse.ie.

For information on how the HSE processes personal information, patients can view the HSE privacy notice below, this can also be found on the Data Protection page under Guidance.

Privacy Notice Summary (PDF, 315 KB, 2 pages)

This rollout supports the long-term objective of expanding Primary Care services aligned to the following:

• 2017 Sláintecare Report (gov.ie)
• 2019 GP Agreement (PDF, size 2.9 MB, 110 pages)

These reports highlight the crucial role played by GPs in the Enhanced Community Care programme and in shifting care provision from acute to community settings.