GPs' co-op service threatened by 'chaos'

A massive upsurge in night-time GP call-outs coupled with a huge funding cut could see the region's North-East Doctor on Call (NEDoC) service "imploding" by the end of this year. The operations manager of NEDOC said this week the programme is in "chaos" and is "unsustainable" while a Navan GP has said he cannot see it survive the winter. The normal operating hours of the NEDoC service (6pm-11pm weekdays, 8pm-11pm weekends) in March saw 255 doctor call-outs, April saw a major increase to 414, and May 443. The increase in GP call-outs to patients' homes comes in the months after grant funding to the co-op was slashed on 1st March, NEDoC's Arlene Fitzsimons said that, since 1st March, grant funding for the programme, which provides urgent out-of-hours GP care in Meath, Louth, Cavan and Monaghan, has been cut by 67 per cent while calls are on the rise. The 'red eye', or overnight, shift saw 407 call-outs in March, 560 in April and 553 in May. In total, the number of calls received by the service were 5,400 in March, 5,800 in April and 5,800 in May. "The service will implode if this continues," said Ms Fitzsimons. The problems created by the increased number of call-outs to patients' homes is due to the triage process, where patients are assessed for treatment or advice being contracted to a Carlow company, Caredoc, which uses only nurses for the triage process. This was a move NEDoC criticised. "The reduction in funding means reviewing the rostering levels, so in line with the significant impact of less funding, we just don't have the manpower and an increase in house calls is causing havoc," said Ms Fitzsimons. "We're coming into the summer but if it was November to Christmas, calls increase dramatically, and if things stay like this, the service will implode," she added. "While the HSE and the people at Caredoc are doing their best, doctor triage was much more effective," she added. Navan GP Dr Diall Maguire said he cannot see the current NEDoC scheme lasting beyond January. "From 1st July, there will only be three 'red eye' doctors on call for the whole region - Meath, Louth, Cavan and Monaghan. The HSE used to fund two, while the GPs used to fund two but the HSE has cut the funding, so it will be a very limited service considering the distances to be covered," he said. "On that rota, I can't see the system the way it is going beyond January." The increase in call-outs for doctors on the scheme is on the rise and the operators believe it is because of the switch to nurses, instead of doctors, taking initial patient calls and arranging triage. "By definition, nurses naturally can't take the same decisions that doctors can," said Dr Maguire. "So that would result in more call-outs, which are made by doctors, but when you consider that, in a centre, you might be able to see four to six people in an hour, on call-outs, you would be lucky to see one person an hour - it's stretching the limits. NEDoC negotiator Dr Gerard Cummins said that the summer should see a decrease in call-outs but that the winter will be the real test. "Only time will tell," said Dr Cummins. "Come September, there will be serious pressure on the service, on house calls, but the centres should be okay but patients will have to wait longer and the 'red eye' service will have problems," he predicted. The HSE responded by saying that following recommendations from the National Review of GP Out-of-Hours Services, a nurse triage system was introduced in NEDoC from 28th March 2011. A spokesperson said: "All co-ops across the country operate a nurse triage system. Nurse telephone triage is supported on the basis that it can be quality assured through the nurse clinical support systems and provides standardisation to the triage process nationally. Nurse triage has been operating effectively since its introduction to the North-East Doctor On-Call Service. "In April 2011, 7.5 per cent of calls required a house visit and this compared with doctor triage for the same period in 2010, where seven per cent of monthly calls required a house visit. "NEDoC currently operates at a seven per cent house call rate. This is below the national average, which is running at about nine to 10 per cent for house calls."