Marian Harkin (Sligo-Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

I have serious concerns about the NowDoc service. The NowDoc service is an out-of-hours GP service covering three municipalities, Carrick-on-Shannon and Ballinamore in south Leitrim, and Boyle in north Roscommon. There is a possibility that this will be privatised and moved from HSE control. I am concerned about the impact of that. There is a probability, which I will explain in a moment, that this change would ensure that out-of-hours calls would be diverted to a centre in Carlow and that out-of-hours services in Carrick-on-Shannon would be diverted to Sligo after midnight.

I have here a consultation document examining the GP out-of-hours service in Donegal and south Leitrim, NowDoc. The document considers the objectives and some of the proposed options. One of the options proposed in phase 1 is to examine the options available to locate Carrick-on-Shannon under Sligo Caredoc. There are many issues with the NowDoc service and I do not have time to go into them. I want to focus on the possible closure of the Carrick-on-Shannon office after midnight.

As of now the NowDoc out-of-hours GP service covers just more than 70% of the week, operating from Monday to Friday from 6 p.m. until 8 a.m. and 24 hours on Saturday and Sunday. That comes to 118 hours per week, which is significant. However, under these proposals there may be a cut in the out-of-hours service from 118 hours to 62 hours per week because if the service in Carrick-on-Shannon is to finish at midnight any client who requires the out-of-hours GP service would have to be directed to Caredoc in Sligo - a round trip from Carrick-on-Shannon of 108 km or from Ballinamore of 128 km. It is clear from the options presented in this document that if this goes ahead, in a few years rural areas particularly south Leitrim and north Roscommon will not be well served.

I want to ensure that optimum care is provided in the NowDoc area so that people can access out-of-hours GP services in a timely fashion. I am aware that NowDoc and Caredoc have identified a number of concerns that impact on patient safety and quality of service. They are listed in this document and they need to be dealt with. It is crucial that whatever changes are made must benefit patients. They must provide a safe service but they must also ensure greater access to healthcare rather than any diminution of services. As I said, some of the options presented in this consultation document would result in a withdrawal of certain out-of-hours services from Carrick-on-Shannon. I raised this issue this evening to highlight it and to look for a guarantee from the Minister of State that there will be no diminution of services under any changes proposed to this service.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue. The provision of out-of-hours GP care is a fundamental component of general practice and appropriate access to GP out-of-hours services must be maintained.

Under the general medical services scheme, contracted general practitioners must make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside normal practice hours. Most choose to participate in GP out-of-hours co-operatives or other GP out-of-hours service providers to meet this contractual requirement. These services have developed and expanded over time and are now an essential part of our primary care services. Access to GP care outside of usual practice hours is necessary to ensure, to the greatest extent possible, that urgent care needs are met in the community rather than in an acute care setting.

The NowDoc out-of-hours service provides urgent GP care to patients of County Donegal and south Leitrim. As the Deputy will be aware, while GP out-of-hours services are largely provided by private co-operatives, the NowDoc service is run and managed by the HSE in partnership with Caredoc, which provides GPs for the delivery of care.

The HSE community healthcare organisation, CHO, for the region concerned has advised that it has entered exploratory discussions with relevant stakeholders to examine the most effective arrangements needed to continue to deliver a safe, quality-driven service for County Donegal and south Leitrim. This examination of the service forms part of the HSE response to significant clinical concerns raised by the Caredoc GP board members.

The HSE has given assurance that no decision has been made on the redesign of the operating model for those areas, and no decision will be made without the active involvement of relevant stakeholders. The HSE will continue to communicate and engage with all relevant stakeholders to ensure they are fully consulted regarding any future developments.

The HSE CHO has confirmed that there are currently no plans to move the treatment centre from Carrick-on-Shannon or change the level of services provided there. It should be noted that the GP out-of-hours service for Sligo and Leitrim is managed as a singular model of service through a service level agreement with Caredoc. As this model is operating effectively, it is not included in the current examination under way.

Regarding out-of-hours services in general and across the country, the HSE engages regularly with all service providers and provides significant supports towards service delivery. The out-of-hours support grant that has been in place since 2020 was increased this winter. Additional temporary funding has also been provided to out-of-hours service providers to allow the rostering of more doctors in treatment centres between the hours of 6 p.m. and 10 p.m. This allows for more patients to be seen over this busy winter period and helps reduce the need for emergency department attendance.

Service quality and patient safety in the delivery of out-of-hours GP care remain paramount for the HSE, and direct its decision making on the provision of services by providers including NowDoc.

Marian Harkin (Sligo-Leitrim, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for that. She said, "The HSE has given assurance that no decision has been made on the redesign of the operating model for those areas, and no decision will be made without the active involvement of relevant stakeholders." It is fine that there are no plans. However, this is the document I am concerned about. This is the consultation document that the HSE has put out there. One of the options is to locate Carrick-on-Shannon under Sligo Caredoc. The options cover three phases and this is right up there in phase 1, which means we can be sure that this is an important part of what the HSE is considering.

I am concerned that we may end up at the point where the service is not designed to suit the people but is designed the other way around and the people have to travel long distances to access healthcare to suit the service. Any service needs to consider settlement patterns, especially where there is dispersed population. That needs to be taken into consideration when designing services. This option is the very opposite. The Minister of State can understand that people are concerned when they see this. It is not a plan or a decision right now.

The purpose of my contribution is to try to impress on the Minister of State and the decision-makers that it must not become a plan or decision. Too often, we read lovely words about streamlining, consolidating, centralising and redesigning. Those are lovely words that at the end of the day often mean a reduction in services. I would not like that and do not want to see it happen.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy. Her point is well made. To reiterate, the HSE continues to work in partnership with NoWDOC and Caredoc to ensure the delivery of a safe and appropriate GP out-of-hours service. No decision has been made with regard to any redesign of the service in the area and any such decision will involve the stakeholders concerned. The HSE CHO has confirmed that there are currently no plans to move the treatment centre from Carrick-on-Shannon or to change the level of the services provided there. The Deputy is trying to ensure that does not happen. I assure her that while the HSE CHO concerned is currently examining the delivery of out-of-hours services for the area, no decision has been made and, in particular, there are no plans currently in place to move the Carrick-on-Shannon treatment centre or to change the services provided there. I take on board the points the Deputy has made about the importance of out-of-hours services provided by Caredoc and NoWDOC, or whatever other services are being provided. Those services are hugely important, especially for those who are living in predominantly rural areas, small villages and towns. I will raise the Deputy's concerns with the relevant CHO.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

I hope the HSE is not engaging in a form of verbal sleight of hand when it talks about there being no plans in place. I am sure Deputy Harkin will bring the matter back should the need to do so arise. Hopefully, as the Minister of State has indicated, there will be no need-----

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Please God.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

-----to revisit that particular matter.