Dáil debates

Wednesday, 15 June 2011

Adjournment Debate

General Practitioner Services

10:00 pm

Photo of Brendan SmithBrendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Ceann Comhairle for giving me the opportunity to raise this important issue. I am glad that the Minister of State, Deputy Shortall, is in the Chamber as she has responsibility for the primary care sector in the Department. The proposal to end the GP service at the north-east doctor on call, NEDOC, centre in Cavan after 10 p.m each night is the cause of serious concern throughout a very large part of County Cavan. The centre is located on the grounds of Cavan General Hospital and is centrally situated to provide an out-of-hours GP service. Over the past 24 hours I have had numerous calls from the public, from people who availed of the GP services, from elderly people worried about this development and from parents who had to bring children to the centre for treatment.

NEDOC covers a huge geographical area from the outskirts of Dublin city to west Cavan, west of Bawnboy village and as far as Carraigallen, County Leitrim. It embraces counties Monaghan, Meath, Louth and that part of County Leitrim. There are four treatment centres at Cavan, Castleblayney, Drogheda and Navan. The proposed restructuring of the service from the end of this month will mean there will be no duty service at the Cavan centre after 10 p.m. Such restructuring will reduce the number of doctors working at night from four to three, with the Cavan centre alert losing this vital service.

I understand the board of directors at NEDOC has been liaising with the HSE for months and outlining the need to adequately fund the scheme and retain the current complement of doctors in order to continue the existing night service. The medical people and particularly the doctors have always stated that four doctors should work at night in order to ensure patient safety and the quality of the service. We are talking about dividing four counties into three. Cavan and Monaghan are large, rural counties. If this proposal is allowed to proceed, it will place a further burden on doctors in County Cavan to travel long distances to provide night services from the other centres on a rota basis. Doctors are busy in their practices. An inevitable consequence will be increased patient referral to accident and emergency units and the increased use of ambulances. An important consideration is the additional cost to patients getting to the treatment centres. Not every family has a car. Many elderly people depend on family members to bring them to treatment centres. If this proposal is enacted, certain parts of County Cavan will be more than one hour from the nearest treatment centre. That would be unacceptable to the people.

It is ironic that in the recent HSE report on services for 2010, the progress made in the past year in providing more services in the community was mentioned. I trust the drive to provide more services away from our hospitals, in the community, will be continued and intensified. If this proposal is allowed to proceed, it flies in the face of the policy, which has so many attributes. I implore the Minister of State to intercede with the HSE to ensure the current level of services provided at night by GPs is continued.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)
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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.

The Dail adjourned at 10.40 p.m until 10.30 a.m on Thursday, 16 June 2011.