Róisín Shortall (Dublin North West, Labour)

The provision of GP out-of-hours co-operatives throughout the country is an essential part of our health service policy of strengthening primary care services and ensuring that, to the greatest extent possible, care needs are met in the primary care setting. Out-of-hours co-operatives are now in place in all HSE areas, providing coverage in all or in part of all counties. The service can be accessed through a single lo-call telephone number in each region and caters for both public and private patients.

Out-of-hours co-operatives allow GPs to manage the provision of urgently needed care for their patients while their surgeries are closed in the evenings, at weekends and on public holidays. The co-ops also afford GPs reasonable, off-duty arrangements. While there is no obligation on GPs to participate in these co-ops, under the GMS contract, GPs have a responsibility to enable contact to be made with them or a locum for emergencies outside normal practice hours. As matters stand, it is a matter for the GPs how they arrange this cover. I accept that this is not entirely satisfactory and this is a matter of concern to me.

The NEDOC GP out-of-hours service has been in place for the past ten years and facilitates a pooling of resources and a rota arrangement. The GPs provide the service with appropriate supports from the HSE, with the aim of providing a quality service to the patients in the north east, outside of normal surgery hours, in respect of urgent, non-routine cases. GPs put in place a revised rota from March, which includes a GP in each of four treatment centres during core hours and a number of GPs available with cars to attend home visits. Since March, there have been four GPs available on the 11 p.m to 8 a.m shift, seven nights a week, known as the red eye shift. NEDOC has indicated in recent days that it intends to reduce cover on the red eye shift to three GPs with effect from July. It has also indicated it intends to reduce some core hours during the summer months and these will be restored during the busier winter period.

The HSE is awaiting the revised rota from NEDOC and will evaluate this against activity. The budget for the NEDOC service in 2010 was €7.735 million, while the national budget for GP out-of-hours services in 2010 amounted to in the region of €98 million. The HSE completed a national review of GP out-of-hours services in March 2010. This was the first national review to be undertaken since the commencement of publicly funded GP co-operatives in Ireland in 1999 and provided an opportunity to consider the nine national GP co-ops and the four extended hours services.

The review makes 13 recommendations designed to strengthen and standardise the service across the country. These include the recommendation that all co-ops move to a nurse triage system. This recommendation was implemented in NEDOC in March. Trained nurses provide the triage service supported by computer-assisted decision making software. The progress in the establishment of GP co-ops since 1999 is considered by the HSE to be a highly significant quality initiative for patient care, general practice and the health service as a whole.

I am concerned about the issues raised by Deputy Smith. I ask him to communicate with my office and provide me with details on where complaints have arisen, the numbers and the times. I will personally follow up on these complaints.

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