HSE Publishes National Review of GP Out of Hours Services

The HSE has recently published the first national review of GP Out of Hours
Services around the country since the commencement of publicly funded GP
Cooperatives in 1999. The report found that there were almost one million
contacts with GP out of hours services in 2008 and that patient
satisfaction is rated at over 90% for the majority of the out of hours

The review examined the nine GP co-operatives across the country which
provide an evening/nighttime, weekend and bank holiday GP service to
patients and the four extended hours services in Dublin (see below). The
development of the service over the ten year period (1999 – 2009) has led
to a successful and highly significant quality initiative for patient care.
The report was conducted to review the local arrangements that have
developed over this ten year period to see what works well for patients and
to identify where greater value for money can be achieved to ensure the
continued provision of service and the development of the service in parts
of the country which do not currently have a GP out of hours service.

The report makes 13 recommendations designed to strengthen and standardise the GP Out of Hours Service across the country. Key recommendations include that the service would be extended to cover parts of the country where there is currently no out of hours provision such as Dundalk, Limerick, Sligo, Tullamore and Tallaght. Each of the four HSE regions will now engage with non-participating GPs to ensure 100% out of hours coverage nationally.

Consistency in quality and standards will be ensured by introducing a
standard contract between the GP cooperatives and the HSE across all of the
services defining roles and responsibilities and clearly setting out items
such as risk management policies, governance arrangements, clinical
governance and complaints procedures, etc.

Nurse telephone triaging should be introduced in all services. This means
that patients who call the service will speak with or receive a call back
from a nurse to discuss their condition, get advice and decide if they need
to be seen by the GP. Having nurses triage all calls is recommended on the
basis that it can be quality assured through a clinical decision support
system already in place in some cooperatives, it is cost effective and will
ensure a standard and effective service across the country.

As the HSE funds the service, the report also deals with strengthening
financial control and assurance for the HSE. It recommends that all
payments to GPs would in future be submitted through a secure online system to the HSE’s Primary Care Reimbursement Service rather than the manual system currently in place.

The report was presented to GP co-operatives recently and has been given to
the HSE’s Regional Director of Operations with a view to agreeing
implementation plans with GP cooperatives at a local level.

GP Out of Hours Service
Geographic Area
Longford, Laois, West Offaly, Westmeath – excludes Moate

Caredoc Carlow, neighbouring areas, Kilkenny, South Tipperary, Wexford,
Waterford, Wicklow town and South Wicklow

NeDoc Meath, Monaghan, Cavan, South Louth and Balbriggan – excludes
Swanlinbar, Co. Cavan, Dundalk and Cooley peninsula

DDoc Dublin County line to the North and West and the River Liffey to the

WestDoc Galway City, Ballinrobe, Glenamaddy/Roscommon, Ballina,
South/Mid-Mayo, Tuam, Craughwell, Westport, Achill, Belmullet, South
Connemara, North Connemara

ShannonDoc Clare, North Tipperary, and County Limerick – excludes
Limerick City

KDoc County Kildare and the area of West Wicklow

SouthDoc Cork and Kerry

NowDoc Donegal, south Leitrim and north Roscommon – excludes Sligo

Extended Hours’ Cooperatives
LukeDoc Rathmines, Rathgar, Rathfarnham, Templeogue and Terenure

DL Doc South County Dublin

EastDoc South East Dublin City

DubDoc Dublin 2, half of Dublin 6, Dublin 8, 10, 12 and parts of Dublin 20