More than one million still lack access to out-of-hours GP care

The latest edition of the Ethical Guide from the Irish Medical Council sets out below the requirement for the doctor to make sure the patients are always covered. There is no derogation for the doctor with regard to the out-of-hours period. Previously, doctors did 24/7 call but that has become much less common now. The patient is the patient of the doctor – not of the HSE. That should be borne in mind when you read Minister Harney’s comments below. It is not a good thing that the HSE officialdom takes over the practice of medicine. Also look at the extraordinary cost involved in these services. We could provide an appropriate service much more cheaply in my view.

The culture in Dublin in the past where small hospitals looked after the local population was not all that bad. The atomisation of medicine at present is making care very discreet and much more costly. There is a dearth of political and true professional leadership in this state.

The Ethical Guide Page 57

Locum and rota arrangements

63.1 You should ensure that the safety and welfare of your patients is protected during your absence. If you arrange replacement cover, you must ensure that the locum doctor is appropriately qualified, registered and in good standing with the Medical Council. As far as possible, patients should be told in advance about the temporary arrangements that will be in place during your absence.

The report on current out-of-hours primary care from a HSE perspective is reported in the Irish Independent on 20 April 2010 By Eilish O’Regan and Anita Guidera:

Health Minister Mary Harney yesterday expressed concern that more than one million people still do not have the benefit of guaranteed Health Service Executive-backed GP cover at night and over weekends.

A HSE survey has revealed that areas which still lack any of the HSE-funded out-of-hours GP co-operatives include Limerick city, with a population of more than 70,000, and Dundalk, Co Louth, with has a population of 35,000.

The whole of Co Sligo, the suburb of Tallaght in south Dublin, and the towns of Moate, Co Westmeath, and Tullamore and Edenderry in Co Offaly also have no access to a GP service.

There are nine GP co-ops countrywide, where doctors arrange round-the-clock rosters at a cost of €107m to the HSE. These co-ops are separate from surgeries which may — or may not — hire locum services or have informal arrangements agreed between doctors in a specific area.

The survey also found that there were almost one million visits to the services in 2008.

Referring to the one million consultations, Ms Harney said: “The issue is the seven areas that don’t receive coverage. Sometimes GPs have been reluctant to put themselves in out-of-hours co-ops. We need to talk to the GPs in these areas.


“It is a big issue in Tallaght, just as it is a big issue in Limerick. A couple of years ago we had no service in the north side of Dublin for 500,000 people.

“We now have a service in place on the northside; that took quite a length of time to negotiate with the GPs to provide that service,” she added.

Under the co-op scheme, doctors can operate from HSE-funded treatment centres, hire nurses to filter calls and avail of a driver for night-time house calls. Patients with medical cards are fully covered, while private patients pay a normal consultation fee.

One of the striking findings was that 244 drivers at the disposal of the doctors earned €11.5m in a year, after receiving €124 to €162 (after
midnight) per house call. The payments are higher than doctors’ fees.

Patients without access to the co-op system of GP care can encounter a “hit-and-miss” response if they need to see a doctor out of normal office hours and the absence also places a greater burden on hospital emergency departments.

The report called on all HSE regions to get into talks with GPs who are outside the co-op system to take part in the service.

The report revealed:

  • GPs are getting payments of €60 to €100 for out-of-hours visits to private patients.
  • GPs get €46 for each medical card patient who visits the treatment centre and up to €93 for each home visit.
  • In 2008, the doctors saw 312,000 private patients.
  • Fees from private patients yielded an income of €18.76m to the GPs.
  • Some co-ops use up to 57 drivers (for example, Southdoc in Cork) — but there are just six servicing the KDOC service in Kildare.
  • Patient satisfaction levels with the service ranged from 50pc to 98pc, with the majority in the over-90pc bracket. Those least satisfied — mainly due to a doctor’s lack of information on their medical history — had long-standing and complex illnesses.
  • A total of 1,732 medical card doctors (81pc of medical card doctors) are members of co-ops and another 234 co-op members are private GPs (3pc of the number of GPs countrywide).

– Eilish O’Regan and Anita Guidera

Irish Independent