Séamus Kirk (Louth, Fianna Fail)
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I do not intend to delay the House, other than to inquire with the HSE, via the Department of Health and Children, when the doctor on call scheme will be extended to all parts of County Louth. Many parts of the country now have this excellent service and where it is available, the service has enhanced patient care considerably. The elderly living in isolated areas have particularly benefited from the availability of doctors on a round the clock, seven days a week basis.

While the range of services provided for care in the community has grown significantly, there are pockets where the doctor on call scheme is not available. There may be local reasons and justifications for this or there may be no justifications for its not being available. County Louth has experienced a rapid population growth in the past five or six years as a result of the upturn in the economy and every part of the county needs a doctor on call service.

When the doctor on call service is available in other parts of the country, the pressure on accident and emergency departments is considerably reduced. The need for people to be rushed to hospital because of the unavailability of a doctor often means that family members must provide the transport. In turn, this brings people into accident and emergency departments who should be dealt with in a home setting. There is a clear need to accelerate efforts to put in place a full doctor on call scheme countrywide.

My interest tonight is parochial and relates to County Louth. When can we expect to have a comprehensive doctor on call service available?

Seán Power (Kildare South, Fianna Fail)
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The development 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 allow general practitioners to put in place arrangements to provide services to their patients while their surgeries are closed in the evenings, at weekends and on public holidays. These co-operatives offer responsive, high quality services, which are delivered by on duty doctors, nurses and secretarial staff in well equipped, modern clinical centres. The service can be accessed through a single lo-call telephone number in each region.

Organised co-operatives enable general practitioners to manage the provision of urgently needed care in a way that affords them reasonable off duty arrangements. This is an important resource which helps to maintain and sustain GP services provided by single-handed doctors and other smaller practices in rural and deprived urban areas. Out of hours co-operatives are now in place in all Health Service Executive areas providing coverage in all, or in part of all, counties.

Between 2000 and 2005, my Department allocated approximately €105 million to the HSE for out of hours GP co-operatives. Almost €34 million is available to the executive for these services in 2006. In 2007, a further €3 million has been allocated to meet the full-year cost of co-operative developments commenced in 2006.

North-eastern doctor on call, NEDOC, is a partnership between the HSE and participating general practices in the north east. There are 48 GPs with general medical service contracts in County Louth and 21 of these participate in the co-operative. NEDOC provides out of hours services to patients of participating practices from 6 p.m. to 8 a.m., Monday to Friday, and around the clock at weekends and on public holidays. The service was established in September 2000 and more than 400,000 care interactions have been provided to date. A recent patient satisfaction survey recorded extremely high satisfaction levels, with 96% of respondents saying they were satisfied with the service. Between 2000 and 2006, more than €15 million was allocated to the former North Eastern Health Board and the HSE for the expansion of the out of hours co-operative in the north-eastern area. This dedicated funding does not include fees paid to participating practitioners for attending patients.

There are four main treatment centres in NEDOC based in Castleblayney, Cavan, Drogheda and Navan. There are also ten peripheral centres where GPs can arrange to meet patients nearer to their homes when required. I have been advised by the HSE that the Dundalk area is not covered by NEDOC as the majority of GPs practising there have declined to join the NEDOC co-operative. There is also an insufficient number of GPs willing to participate in the co-operative to enable the executive to establish a treatment centre in Dundalk.

There is no contractual obligation on GPs to participate in these co-operatives and these GPs are providing out of hours cover to their public patients through agreed rota arrangements in accordance with their GMS contracts. The HSE has confirmed that it will continue to work towards the extension of the GP out of hours co-operative to all GP practices in the north east and, in particular, that it will continue to actively pursue the establishment of a NEDOC treatment centre for the Dundalk area.