NEDOC to stop face-to-face consultations at night

A critical shortage of doctors means the North East Doctor on Call (NEDOC) service is to stop its face-to-face GP consultations after 10.30pm at night.

The out of hours service will continue to provide urgent GP Out of Hours care to patients on a face to face basis until 10.30pm on weekday evenings and 10pm at weekends, but patients will then only have access to GP telephone advice.

The new system will come into effect on Tuesday 4th August.

Patients of participating practices will have access to urgent appointments in the NEDOC treatment centres from 6.30pm-10.30pm Monday-Friday and from 8am-10pm at weekends.

From 10pm onwards, patients will be triaged by a nurse and referred onwards for GP triage if that is subsequently required. There will be no in-person appointments or home visits provided by the centrally triaging doctor.

“The changes are as a result of acute doctor shortages and underfunding of the service by the HSE,”says Operations Managr, Arlene Fitzsimons.

The HSE has been notified of the issues facing NEDOC for overnight sessions for some years and while some financial supports were forthcoming they were insufficient to cover the costs incurred in sourcing doctors to work these overnight shifts.

The NEDOC GP Out of Hours service is primarily resourced by daytime GPs who work in their surgeries and then work evening, weekends and bank holidays to ensure a service is provided to patients. The majority of GPs hold a GMS contract that requires doctors to have a system in place for patients to contact them if their urgent care cannot wait until their own GP surgery opens the following day/Monday.

According to Dr Seamus McMenamin, Chairman of NEDOC Ltd, “NEDOC was established as an urgent out of hours GP service, however with time the service has become a convenient alternative to day surgery while also being the stop-gap for other health services that choose not to arrange out of hours cover but allow their patients to default to NEDOC, services such as public health, mental health, social care, dental care as well as palliative care which has limited resources to call on. “Clearly there is a demand for an out of hours service for primary care, however it cannot be expected that this will be provided by GPs that are already overburdened in their daytime practices.

“We would like to engage with the HSE to discuss how such a service could be provided with GP support but to date our requests to meet HSE officials to address the issues facing the service have been refused.” he added. Ms Fitzsimons has been engaged in a recruitment campaign to attract doctors to the service. “GPs in the region have participated in the NEDOC service to ensure their patients have access to urgent out of hours care, however GPs cannot work overnight and into their day surgery, therefore we have always relied on GP locum colleagues to bolster the service overnight, and also for some weekend or evening sessions.

“To have the support of these highly qualified doctors is essential to the provision of our service. We successfully navigated the covid era as doctors became unavailable, however now the medical manpower market is so competitive that it is increasingly difficult to source doctors under the terms and conditions we can offer. In order to attract doctors to Ireland or retain the doctors that have already trained in Ireland, we need to be able to offer better terms and conditions and to do that we need HSE support which is not forthcoming.”

Dr McMenamin added “Daytime GP services are overwhelmed as GPs work regular 12 hour days to deal with appointments, phone calls, advocacy for patients, referrals to hospital and administration of their practices.

“We have to safeguard general practice as GPs are increasingly reporting burn-out from the demand in both daytime and out of hours. We want to continue to have a high quality out of hours service however we need the HSEs support to help us to encourage other clinicians to join our out of hours team so that we can continue to provide this service to our patients.”

Arlene Fitzsimons added, “in 2019 we had an exceptionally high level of demand with 90,000 calls to the service. While there was a dip in contacts in 2020 due to covid, the number of contacts rose again to 84,500 in 2021. Already to the end of May this year the number of contacts to the service has exceeded those of 2019. GPs no longer have the capacity to take on a higher level of rostering in the out of hours. If this level of rostering is a requirement of the HSE, and if they wish to provide a convenient out of hours GP service, they need to participate in discussions with us as to how that can be provided without the expectation falling solely on GPs who are already at capacity in their practices.”

She said that of particular concern to the Board and GPs within NEDOC is the impending closure of Navan ED by a replacement GP referred AMAU.

“General Practice does not have capacity, either in daytime or OOH, to be the system of referral for the AMAU and there has been no communication from the clinical group or the hospital in respect of this additional burden of work that is being put upon General Practice.

“This referral process will not be provided by NEDOC. It is of grave concern that potential stroke and chest pain patients will have their essential immediate treatment delayed due to not having direct access to the AMAU. “