One small change: A GP on how to make Ireland’s health system better

Dr Phillip Sheeran-Purcell thinks health service communication should be online

As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear from doctors, nurses, paramedics, medical secretaries, hospital porters, canteen staff and others about one change they would like to see in our health system.

It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone.

Dr Phillip Sheeran-Purcell

(GP in Co Wicklow)
"Good communication is the backbone of every effective service but, unfortunately, in the Irish health service, we still share a lot of information via letters and faxes.

“As doctors working in Covid-19 community hubs during the pandemic, we saw how things could be suddenly changed for the better. Covid test and assessment referrals were electronically delivered and the public adapted quickly to receiving appointments and test results by text. Prescriptions were – and continue to be – delivered electronically to pharmacies rather than via a GP’s handwritten script brought by the patient to the pharmacy.


“GPs have been computerised for two decades with secure electronic Healthmail and Healthlink systems, however we still send referral letters by post to consultants which can take days – if not weeks – to be processed through the system.

“Following on from Covid pandemic, my local HSE colleagues and I began working to spread the use of electronic referrals [e-referrals] within our primary care team. Simply put, any patient, while with their GP, can see the e-referral sent immediately to any other healthcare professional and know that their doctor will get a receipt of delivery and confirmation that it is being dealt with within 24 hours.

“Also built in is confirmation of the availability of the service – which is important if a service isn’t currently operational – and an estimate of the lead-in or waiting time. In the future, this service will be available to all other health professionals in the primary care team including psychologists, occupational therapists, etc. We also hope that treatment updates and progress summaries will return electronically.

“These e-referrals are now becoming the standard communication method in our area and will hopefully roll out nationally. E-referrals deliver an immediate, encrypted start to the referral process which will help patients progress towards the care they need in a quicker and more transparent way.

“But, while this is progress, the current standard means of communication across large swathes of the health services is still via letters sent by post. This is unwieldy, expensive, unreliable, un-environmental and at odds with the essentially paperless systems of modern primary care practice. It has to change.”