GP Access to Community 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, 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), & 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 GP Access to Community Ultrasound FAQs (PDF, size 347 KB, 12 pages) 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.

MRI

Brain: MRI Brain, MRI Brain & 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.

CT

Brain/Sinus/Neck: CT Brain, CT Brain & Sinus, CT Sinus, CT Neck

Spine: CT Cervical Spine, CT Lumbar Spine

Thorax/Abdomen/Pelvis: CT Neck & Thorax, CT Thorax, CT Thorax HRCT, CT Thorax & Abdomen, CT Abdomen & Pelvis, CT Abdomen (Liver, Pancreas), CT KUB/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 & 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 see the FAQ document for information on accessing the guidelines GP Access to Community Diagnostics and GP Access to Community Ultrasound FAQs (PDF, 347 KB, 12 pages). 

Where to refer for imaging

The Community Healthcare Organisation (CHO) Matrices (see related files below) provide information on locations to refer your patients. For the outsourced service, you can refer your patients to any location regardless of the CHO your practice is located in.

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.

Mobile Imaging – Mobile Medical Diagnostics

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, 01 575 09908

Email: info@mobilemed.ie

Website: www.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 ED department

The service is currently running in Dublin, Wicklow, Meath, Kildare, Louth, Cork, Limerick, Clare, North Tipperary, South Tipperary, Carlow, Kilkenny, Waterford, Wexford, Galway, Mayo and Roscommon. The service will be available nationwide by the end of March 2024.

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/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). Please note the new code: ‘GP Access to Community Diagnostics,’ which should be used for referrals for X-ray, CT, MRI, and DXA or ‘‘GP Access to Community US’ if referring for US. Please provide the Medical/GP visit/HAA card number if referring for US. You must also include the following information specified below in the free text box on the General Referral Form:  

#	Information Required in General Referral Free Text Box	Example
1	Code: ‘GP Access to Community Diagnostics’	GP Access to Community Diagnostics
2	CHO	CHO 1
3	County	Cavan
4	Medical card or GP visit card number, only for GP Access to Community US scheme (8 characters)	A1B23456C
5	Modality	CT
6	Part of the body to be scanned (depending on the type of scan being requested)	Sinuses
7	Urgent or Routine	Routine
8	Patient mobile number (if not provided already)	086-1234567
9	Relevant clinical information, including previous imaging and where it was done	MRI Brain at St James’ Hospital

Where applicable, all the above information must be correctly specified on the referral, particularly the valid medical card or GP visit card number. You can find further information in GP Access to Community Diagnostics and GP Access to Community Ultrasound FAQs (PDF, size 347 KB, 12 pages).

You can also refer to Mobile Medical Diagnostics via Healthmail. A referrer must complete an order form and it must be sent via Healthmail to info@mobilemed.ie.If referring via Healthmail please include the following information:

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. Body part to be x-rayed
6. Clinical indications e.g. fall, ongoing pain etc
7. Query e.g. fracture, LRTI etc
8. FEMALE - Last menstrual period (LMP) start date if applicable (12-55 yrs) (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 & 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) regardless of their GMS status (public or private patient). For more information, please see the FAQ documents: 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 Flowchart (PDF, size 660 KB, 1 page) and Spiro Flowchart (PDF, size 640 KB, 1 page). Patient Information leaflets are available here Echo Patient Information Leaflet (PDF, size 443 KB, 2 pages) and Spirometry Patient Information Leaflet (PDF, size 202 KB, 2 pages).

For Echocardiography, please refer to the National Model of Care for Heart Failure, GP Reference Summary for Heart Failure Diagnosis and Management (icgp.ie), GP Quick Reference Summary for Good Practice Points on Cardiovascular Disease (icgp.ie) and Overview | Chronic heart failure in adults: diagnosis and management | Guidance | NICE (nice.org.uk)

Regarding Spirometry to guide your decision-making for COPD, please refer to the End to End COPD Model of Care (PDF, size 2.1 MB, 86 pages) and GP Quick Reference summary for COPD (PDF, size 1.8 MB, 28 pages). Please refer to the End to End Asthma Model of Care (PDF, size 5.4 MB, 67 pages and the Quick Reference Summary for Asthma (PDF, size 1.9 MB, 57 pages). In addition, please consider whether the patient meets the referral criteria as set out in the FAQ documents Echo FAQ (PDF, size 867 KB, 6 pages) and Spiro FAQ (PDF, size 907 KB, 8 pages).

Where to refer for Echocardiography and Spirometry

GPs will be contacted by their CHO/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 FAQ (PDF, size 867 KB, 6 pages), Spiro FAQ (PDF, size 907 KB, 8 pages) and A Guide for Referral of Patients to the Chronic Disease Ambulatory Care Hub Services (PDF, size 1.3 MB, 26 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 (PDF, size 650KB, 10 pages). This can be found online on the HSE GDPR webpage - GDPR Information - HSE.ie.

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

• 2017 Sláintecare Report (PDF) (gov.ie)
• 2019 GP Agreement (PDF, size 2.7MB, 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.