Gp service cuts met with alarm

The news that North East Doctor on Call (NEDOC) will see a reduction in services from 1st April has been met with alarm across the region.
The service has indicated that due to severe funding restrictions, it can no longer fund four doctors in its four centres right through the night, but the ourof hours GP service it will keep cuts to periods where they would have least impact on patient care.
However, local representatives have warned that the cuts will see greater delays in patients being seen and that the crises in A&E’s in the region will worsen as patients turn to them instead.
Deputy Peadar Tóibin warned that the cuts would have a major impact on health services in Meath.
“When there is a crisis at the Emergency Department, people are told to go to their GP’s. It is already difficult to get an appointment with your own GP during working hours, so you have to wait for the out of hours service.
“This is just another squeeze on citizens of this country,” he said,
NEDOC itself has warned the changes will have a knock-on effect on patient care and more patients may be referred to hospital as a result.
However Arlene Fitzsimons Operations Manager of NEDOC Ltd points out that NEDOC is not a replacement for the emergency services, nor is it a replacement for non-existent out of hours social care, palliative care or psychiatric care services.
Cllr Wayne Forde warned that lives could be lost as the pressure on emergency departments will increase.
“This will force patients to attend emergency departments which are hugely overcrowded and will put even more pressure on them.
“If this is allowed to happen, I believe patients may pay the ultimate price, and lives will be lost.
“I am calling on the HSE and our government parties to immediately secure this extra funding for NEDOC which is an essential service”.
Ms Fitzsimons said there will be a reduction in the number of doctors on duty overnight from 12 midnight from four to three.
“This is one of a number of adjustments that the service has to make as a result of funding restrictions.
“Unfortunately NEDOC Ltd has had to manage significant funding reductions dating back to 2011. At that time the service suffered a 66per cent reduction in funding, and we reduced the roster only by 40per cent and have managed that gap ever since. For the past couple of years NEDOC Ltd has seen the company operate an over-run, which rose to €400,000 in 2014. We must take steps to address that deficit.”
She explained that NEDOC is a partnership between GPs in the NorthEast and the HSE.
“We have been in discussions with the HSE to try to find a solution to the funding deficit. They are still considering the adjustments and I would hope they are able to find a solution that would mean we can retain our existing levels of service”.
She explained that NEDOC has four treatment centres, one each in Drogheda, Navan, Cavan and Castleblayney.
A doctor will continue to be based from each centre until 11pm every night. Howegver, after that, the overnight doctors will start from Navan, Castleblayney and Cavan treatment centres. These doctors will manage patient care across the four centres during the night by scheduling appointments in each centre during set clinic times.
Appointments will be scheduled in each centre during the night to ensure that patients have access to the service. In between those appointments, doctors will undertake home visits as required.
For example in Navan clinic times will be from 6pm-11pm; 3.30am-4.30am and from 6am-7am. Drogheda clinic times will be from 6pm-11pm, 2am-3am and from 5am-6am. Castleblayney clinic times will be from 6pm-11pm; 2am-3am and from 7am-8am. Cavan clinic times will be from 6pm-11pm, 2am-3am and from 6am-7am. In between these scheduled clinics, the doctor will cover home visits across the southern area of the region.
According to Arlene Fitzsimons, “reductions to the services are being made during the times of least impact on patient care. There are an average of 30 calls to NEDOC after midnight. Half of those calls are managed by nurse triage. The remaining 15 are managed by doctors by telephone, or in the treatment centre or at home. To manage patient care with less resources does require a more efficient appointment schedule.”
Other adjustments will see two of the over-night doctors finish at 7am, while the third doctor will remain on duty until 8am. Monday-Friday GP appointments will begin at 7pm each evening, and at weekends GP appointments will begin at 9am.
NEDOC will continue to operate from 6pm-8am Monday to Friday and 24 hours over the weekend. Patients can continue to contact the service from 6pm each evening and all weekend. Nurse triage will continue during all the hours of service.

A spokesperson for the HSE said NEDOC Ltd had submitted proposals to the HSE regarding service adjustments to the GP Out Of Hours Service in the North East Region.
“The HSE will not be making any further comment on these proposals until we have an opportunity to discuss them directly with NEDOC Ltd,” he said.