Jimmy Deenihan (Kerry North, Fine Gael)
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The concept of the general practitioner co-operative has been introduced successfully in Ireland over the past five years. Traditionally, out-of-hours service was provided by general practitioners on an on-call basis. This meant that many GPs, particularly those in single-handed rural practices, could be constantly on-call. Other doctors working in group practices or in urban areas with colleagues in practice nearby were able to organise rotas and secure some time off duty. As demands increased on general practice, the level of out-of-hours calls increased and doctors were becoming increasingly tired and stressed. In response to increased demands on GPs, they began to explore the introduction of the co-operative model of providing out-of-hours services in 2000. This model, which had been in operation in the UK, was introduced to Ireland initially on a pilot basis and has expanded throughout the country in recent years.

In the south west of the country SouthDoc, which commenced in 2001, is a co-operative of general practitioners which provides an out-of-hours service for Cork city and county and most of Kerry. The call centre is located at St. Finan's Hospital, Killarney. The co-op has a board of medical directors and employs a general manager to run the centre. There are different types of treatment centres in operation: overnight centres which are staffed throughout the night; treatment centres which are staffed up to midnight only; and lock-up centres, which are used as a base to see patients but are not staffed.

The location of various centres is determined by the demographics of the region. In general, the treatment centres are based in the major centres of population, large towns and villages such as Tralee, Castleisland and Killarney in Kerry, and Bantry and Cork city in County Cork. Centres are located in order to be accessible within a reasonable travelling time to the population they serve.

In the period 2001 to 2005 the co-op has been rolled out in counties Cork and Kerry and now most of these two counties is covered by the service. Although the scheme has been a major success in these counties, north Kerry remains excluded. Some 14 general practitioners in the north Kerry area, from Kerry Head to Tarbert, have waited to be admitted to the GP co-op scheme for four years and were finally given approval in October 2005, or so they thought. Initially the relevant GPs were informed that the scheme would commence in early 2006. However, they have now been informed that the funding which had been promised to them to run the scheme is available but has not been released.

I wish to stress to the Minister that the extension of the GP co-op scheme is essential to north Kerry, which is predominantly a rural area. The GPs in this area still find themselves excluded from the scheme and have to cover a large rural area without any back-up. Many of them have to work day shifts immediately following what are sometimes lengthy call-outs during the night. Professor Drumm and the Minister, Deputy Harney, surely have a duty of care to the GPs as their employers to ensure the personal safety of these doctors and that they are not at risk while carrying out their duty. These GPs sometimes have to drive long distances at night on their own. This can be stressful and scary for female doctors in particular. If they were included in SouthDoc, these GPs would have the services of a nurse and driver and other back-up services. It is not fair to the GPs in north Kerry.

I call on the Minister, through the Minister of State, Deputy Brian Lenihan, to contact the chief executive of the Health Service Executive immediately so that the funding to get the scheme up and running can be released without further delay. The north Kerry area should not remain excluded from this essential primary care out-of-hours service.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I am taking this debate on behalf of the Tánaiste and Minister for Health and Children, Deputy Harney, and I thank Deputy Deenihan for raising this matter on the Adjournment. The Government is committed to the development of GP out-of-hours services as outlined in the national health and primary care strategies. Currently, out-of-hours general practitioner co-operatives are operating in at least part of all counties in the State.

In the Health Service Executive's southern region, out-of-hours general practitioner services are provided in counties Cork and Kerry by the SouthDoc co-operative. Decisions regarding the geographical areas to be covered by general practitioner out-of-hours co-operatives and any expansion of the services are made by the HSE, which has regard to the strategic, financial and other issues involved, including the readiness of general practitioners within an area to become part of a co-operative.

With regard to SouthDoc, this co-operative was established as a limited company for the provision of out-of-hours general practitioner services in 2001. Initially it began in south Kerry and west Cork. By 2003 it expanded to take in Cork city and in August 2005 it further expanded to north and east Cork. There are 365 GPs participating in the SouthDoc co-operative. It has, on average, 2,250 calls per week, and it provides services to a population of 581,000 people. There are 26 treatment centres. In Kerry, these treatment centres are located in Killarney, Cahirciveen, Tralee and Castleisland.

In 2006, approximately €34 million is included in the HSE's baseline funding for GP out-of-hours co-operative services. Of this amount, €2 million is new funding for this year. In the context of this additional funding, the HSE has advised me it is currently considering the expansion of the GP co-operative service to north Kerry along with proposals for expansion to other areas. The HSE southern area continues to work closely with the north Kerry GPs in terms of moving towards their inclusion in SouthDoc. In 2006, the HSE will have over €6 million available in its baseline funding for the SouthDoc co-operative. Between 2000 and 2005 almost €18 million has been provided to fund the out-of-hours services provided by SouthDoc. These amounts do not take into account fees for attendance on patients that participating general practitioners would receive.