Doctors divided on future of ED

Meath's GPs appear have divided opinions on the proposed to close the Emergency Department at Our Lady's Hospital in Navan.

Local members of the the Irish College of General Practitioners (ICGP) who support the proposed changes, say the current situation is unsafe, while the NEDOC service has expressed concern at the risk of unnecessary treatment delays if the proposals go ahead.

ICGP members have expressed concern over safety at the Emergency Department.

“The ED in Navan cannot adequately provide the sort of specialist care that critically ill patients require. Thus, it is not safe,” according to a statement from the Meath Faculty of the ICGP .

The Faculty is the local branch of the standard setting and educational body for general practitioners.

The statement, which is signed by three local doctors - Catherine Wann, Niall Maguire and Deborah Ryan, said: “There are very real concerns among GPs and hospital consultants at Our Lady's Hospital, Navan (OLHN) that due to the lack of specialist facilities in the ED, critically ill patients are being put at greater risk, with a poorer chance of a good outcome.”

Separately, local North East Doctor on Call (NEDOC) GPs have expressed concern at the risk of unnecessary treatment delays for potential stroke and cardiac patients if the Emergency Dept in Navan is closed.

““We are particularly concerned that potential stroke or cardiac patients will not have direct access to the AMAU and will be required to have a GP referral letter to the AMAU, risking unnecessary delays in their treatment,” said Dr Seamus McMenamin, chair of the out-of hours service.

The ICGP said: “OLHN has continued to provide some of the aspects of a modern ED for the past twenty years, but it is acknowledged by all not to have the resources to provide the sort of safe, expert care that critically ill or injured patients require.”

The statement points out that heart attacks, strokes and major trauma have for years already been brought directly to other hospitals with those resources.

“No doctor, whether working in the hospital or as a GP, could countenance a seriously ill patient going anywhere other than a hospital which has the necessary services and expertise to treat them.

“The GPs in Meath have insisted on being closely involved in the re-design of the service at OLHN.

“Meath GPs have found the HSE and the Ireland East hospital group to be willing to listen and collaborate. GPs have been invited and have participated in senior management meetings as the proposed changes at OLHN were discussed.

“For the past four years, funding has been provided for a GP to help coordinate the development of services at Navan.

“This collaboration between GPs and OLHN has led to the development of innovations such as our dedicated inpatient and outpatient Rehabilitation service, the Frailty service, a Community Respiratory service and our Musculoskeletal Outreach initiative.

“The hospital continues to invest and enhance the delivery of the sort of complex non-urgent tests that GPs increasingly need to look after their patients, such as specialised blood tests, previously only available to hospital doctors, or scans and x-rays that were not available heretofore.”

In their statement ICGP say they have seen the availability of new and expanded medical and surgical specialist services at Navan, such as in haematology, biochemistry, rheumatology, chest medicine, kidney medicine vascular surgery, plastic surgery and urology.

“We have also seen expanded operating lists for elective surgery.

“The GPs represented by the Board of the Meath branch of the ICGP have no doubt that the ED at OLHN is not safe, despite the great effort that goes on there.

“We are reassured that we shall instead have access to a 24-hour, seven day Medical Assessment Unit, and the continued benefit of our excellent Minor Injuries service. We are further reassured that over 30 additional acute inpatient spaces have been created at Drogheda to accommodate transfers from Navan.

“We approach the closure of the ED in Navan with measured concern, but overall, with relief. We especially welcome a 24-hour MAU, only the second hospital in the country to have such a service.”

Meanwhile. NEDOC GPs have expressed concern at the risk of unnecessary treatment delays for potential stroke and cardiac patients if the Emergency Dept in Navan is closed.

Dr McMenamin has expressed his concern at the HSE's decision to close the ED in Navan Hospital, and the impact this will have on the out of hours service, as well as daytime general practice.

“It appears from the plans to close the ED that the Acute Medical Assessment Unit will only be accessible to a patients if they have a referral from a GP. The NEDOC service is an urgent GP service for patients whose care cannot wait until their own GP surgery opens the following day. The service is not there for the purpose of issuing referral letters to the AMAU.

“We are particularly concerned that potential stroke or cardiac patients will not have direct access to the AMAU and will be required to have a GP referral letter to the AMAU, risking unnecessary delays in their treatment.

“GP surgeries are already overwhelmed with pressure to take on more patient care that has traditionally been the remit of the hospital sector. In tandem with that we continue to deal with large volumes of appointments to our surgeries from patients who require immediate care, whose long term care needs were put on hold during covid, advocating on behalf of our patients for hospital appointments, management of chronic care in the community, increasing administration and compliance requirements as well as the day to day management of our practices.

“There is a GP manpower shortage and we are struggling to recruit doctors into our day practices,and have an even greater challenge to do so for our Out of Hours service.”

Arlene Fitzsimons, Operations Manager of NEDOC added

“The NEDOC service received no communication from the hospital group, the clinical leads, Navan hospital or the HSE about the imminent plans to close the ED and replace it with a GP referral AMAU. Nor did the service receive any notification of this workload being foisted upon an already overburdened service and overburdened workforce.

“NEDOC will not have the capacity to be the referral point of contact for the AMAU and serious

consideration needs to be given to retaining the ED in Navan.”