Doc on Call future in doubt as managers warn they 'must consider all options'
The North East Doctor on Call service will have to review the services provided to patients as a result of the decision by Minister James Reilly to impose a further 7.5% cut in funding to GP services.
Funding for the NEDOC GP service was cut in 2011 by almost two-thirds, and translated into a reduction in GP rosters of 40%.
According to Arlene Fitzsimons, operations manager of NEDOC explains that this new cut to GP fees will mean the service 'must consider all options' in terms of the type of service it can continue to provide to patients.
“There is only so much the service can take in terms of funding cuts,' said Ms Fitzsimons. 'We are facing a reversal of years of progress where the flow from the hospital sector to the community and General Practice is going to have to be reversed as we are forced to refer increasing numbers of patients into the Emergency Departments.
“It is ironic that the Minister continues to put forward a strategy of care in the community whilst simultaneously seriously reducing the very resources that will provide that care. Services in the community cannot handle a greater capacity when staff, funding, capital support are all being taken from them.”
Severe effect
The NEDOC service is provided primarily by the same GPs that work in the daytime. According to Dr Séamus McMenamin, chairman of NEDOC, pressure on day and out of hours GP services is growing as doctors are faced with increasing numbers of inappropriate referrals to their surgery and to NEDOC from the hospital sector.
'Attendance rates into NEDOC are rising. Sicker patients who are unsuitable for urgent services are presenting to NEDOC due to fears of waiting times in hospitals. Any further infrastructural changes such as closing of EDs and ambulance cutbacks will risk the safety of the NEDOC service. Ultimately, and as ever, it will be patients that are affected,” said Dr McMenamin.
“These cuts, compounded with the increasing number of patients attending NEDOC, will have a severe effect on the services NEDOC can provide. To a large extent NEDOC is the only service available to patients outside of normal surgery hours in terms of domiciliary visits; public health medicine; psychiatric care; social services; dental care; child welfare; and so on.”
“Last winter NEDOC saw waiting times of 2 hours in some treatment centres. As other services constrict patients will continue to be referred (inappropriately) into NEDOC. We have reached the limits of safety in our view. The HSE will have to consider how to manage the workload as the cuts to GP funding are now so significant that patients will have to be referred to the Emergency Departments or to other more appropriate services. Otherwise our waiting times will soon reflect those of the EDs.”
Inappropriate
According to Ms Fitzsimons part of the problem is that the number of attendances with doctors has risen dramatically in the two years since the change-over from doctor to nurse triage, during which time there have been an additional 10,000 patient-doctor consultations.
'Since the abolition of GP triage there is no system of workload management resulting in long waiting times and inappropriate and unnecessary attendances. The Board of Directors of NEDOC has repeatedly highlighted this concern to the HSE but to no avail. We recently submitted further proposals to improve management of the workload and would hope that the HSE will consider those proposals favourably.”