Lives at risk as Doctor on Call funding is slashed

A stark warning that patients' lives will be put at risk by HSE proposals to slash funding to the North East Doctor on Call (NEDoC) services has been made by local general practitioners. The doctors have warned the out of hours service will be decimated and the proposed cuts would pose a serious risk to patients. The annual meeting of the service due in October could have to consider a winding down of NEDOC by the end of December. The shape of out-of-hours provision after that time remains to be decided, it is understood. The service, which is 10 years old this year, faces HSE cuts of between 50 and 75 per cent, according to operations manager, Arlene Fitzsimons. She said this would result in less doctors being rostered and when a patient calls the service, they would no longer get to speak to a doctor, but a nurse instead. Kells GP Dr Peter Wahlrab, one of the founders of the service warned that lives could be at risk by the funding cut. "It would create a very serious risk to patients. Hospital services in the north east have been severely curtailed due to the HSE's Transformation Programme which is concentrating acute services on two sites, and this has already thrown a significant extra workload on general practitioners," he said. Ms Fitzsimons said NEDoC met with the HSE recently and were told of a new system of fee by item funding, which would see a reduction in funding from the HSE by between 50 and 75 per cent. "Such a dramatic reduction will effect the level of service we can offer," she warned. "We won't be able to roster the same number of doctors, so people will have to wait longer to see a doctor and to get a call back from the service." She said it would also mean that the call back a patient would receive after their initial phonecall would be from a nurse, rather than a doctor. "This means that even more people will be coming to see the doctors, leaving waiting times even longer," she said. "This will decimate the NEDoC services, and all the good work we have done over the past 10 years will be wiped out," she said. "It simply will not be possible to provide the same level of service, with half the money. The HSE wouldn't be able to do it by themselves," she said. Dr Wahlrab said such a major cut in funding would see a substantial reduction in the service. "There would be a reduction in the number of doctors rostered and their availability to see and treat patients in the evenings and at the weekend would be substantially reduced," he said. Dr Wahlrab said he believed the HSE intended to implement these changes on 1st January. "This would be the worse time of year to hamper the ability of an out of hours operation to provide clinical care," he warned. Dr Sean McGrath warned that the NEDoC service was under threat and the proposed cuts would pose a severe safety risk to parents, as they would have to wait longer to see a doctor. He said that general practitioners were now considering what alternatives they have, as their priority is to provide the best possible service to patients. The HSE's proposal that a nurse would call patients back would mean an increase in people coming to avail of the service. "A nurse cannot advise people what to do by phone and they will invite people to come in and see the doctor, yet what the HSE are proposing is a reduction in the number of doctors," he said. He said that at the moment in Navan, there were two cars and two drivers available at every shift, but the funding cuts would mean there wouldn't be any drivers. "We would be going back to doctors using their own cars. At the moment, if a doctor is going on a call out, it is a serious emergency and he or she is usually getting equipment and medicine ready on the journey," he pointed out. A spokesperson for the HSE said a national review of GP Out of Hours Services was completed in 2010 and it is planned to implement its recommendations from the beginning of 2011. She said seven of the country's nine national GP co-ops receive a Special Type Consultation payment per GMS patient treated and two, including NEDoC receive an annual grant payment and the review recommends standardising the payment method across all co-ops to that of Special Type Consultation. "The Review contains a number of recommendations with regard to service quality, triage, and aspects of the service which will continue to be funded and provided by the HSE, such as facilities, staff, and cars. The HSE has advised all co-ops including NEDoC of its intention to implement the review recommendations including payment on a STC basis," she said. "It is envisaged that the review when fully implemented will result in a more cost effective service underpinned by a number of quality and governance principles contained in the service level agreement," she concluded. NEDoC say the other challenge they are facing is the possible closure of the Accident and Emergency (A&E) unit at Our Lady's Hospital in Navan and its replacement with a minor injuries unit, which would be closed at night. Arlene Fitzsimons points out the NEDoC's busiest treatment centre is located in the grounds of Our Lady's Hospital and the fear is that, if people arrive to find the A&E closed, they will try to gain entry to the adjacent NEDoC centre. This would make the service, which is for people who need to see their GP out of surgery hours, unworkable and NEDoC says it would have to look at moving premises. NEDoC provides an urgent GP service to 350,000 patients in Louth, Meath, Cavan and Monaghan, operating from 6pm to 8am, Monday to Friday, and 24 hours at weekends and bank holidays and dealt with its one millionth patient last year.