Róisín Shortall (Dublin North West, Labour)

I thank the Deputy for raising this issue. The provision of general practitioner, GP, out-of-hours co-operatives throughout the country is an essential part of our health service and we fully support that policy in terms of strengthening primary care services and ensuring that, as far as 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. 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. It is a matter for the GPs how they arrange this cover.

The NoWDOC service, which is now ten years in existence, is a co-operative structure between GPs and the Health Service Executive to provide urgent GP services to patients who may require them in the out-of-hours periods, that is, evenings, nights and weekends. It covers Donegal, south Leitrim and north Roscommon, with 98 full-time GPs participating in the service. The budget for the NoWDOC service last year was €3.168 million, while the national budget for GP out-of-hours services last year was almost €100 million. More than 57,000 people contacted the NoWDOC GP out-of-hours service last year and, of these, more than 36,000 were treated at the GP out-of-hours treatment centre or received a home visit. Some 33,600 people contacted the NoWDOC service in the first six months of this year.

In terms of the partnership that exists between the GPs and the HSE, the HSE provides the infrastructure for the service, including support staff, such as drivers, receptionists, nursing staff and so on. The GPs provide the cover for the various doctor rotas for the out-of-hours periods. All calls to the service are handled and triaged in the call centre in Letterkenny and treatment centre visits are arranged by appointment only.

The HSE west is currently reviewing the NoWDOC services. This follows directly from the recommendations of the national review of GP out-of-hours services which was carried out and published in 2010. The HSE, in implementing the recommendations of the national review, is looking at all operational activity, including staff who are employed by the HSE, to ensure that safe and efficient services can be maintained in the current difficult financial environment. This review to date has resulted in the HSE submitting proposals to the trade unions regarding the redeployment of receptionist staff and the expansion of the drivers' role under the provisions of the public service agreement 2010-2014. These discussions are ongoing and will be concluded in the coming weeks.

The proposed changes reflect the staffing models that operate elsewhere throughout the country and will provide for the continuity of safe patient care at each of the centres which are affected in this proposal, that is, Derrybeg, Carndonagh, Mountcharles and Carrick-on-Shannon.

At the annual general meeting of NoWDOC Limited, the GP members of NoWDOC passed a motion to form a sub-committee to examine viable options for the provision of GP cover for red eye periods and submit proposals to the HSE to outline how such cover might be provided more efficiently without compromising patient safety.

The outcome of the GPs review has not yet been finalised and no proposals have been submitted to the HSE for consideration. While changes to service delivery arrangements may be proposed in the future, the issue of curtailing or reducing services has not featured in any discussions to date. Again, I thank the Deputy for raising this matter.

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