GP co-ops warn HSE of plans to ‘work to contract’

The National Association of GP Co-ops has warned it can no longer provide out-of-hours (OOH) services to patients who are not registered with a GP.

It also intends to advise patients with non-GP requests, such as dental presentations, to seek care elsewhere.

In July, the Association sent a letter to the HSE, and copied to the IMO and the Minister for Health Stephen Donnelly, outlining its concerns about the future of GP OOH services.

In the letter, seen by the Medical Independent (MI), the Association outlined its plans in response to a lack of engagement from the HSE and health management in addressing the concerns of GP co-ops.

“As an immediate measure, co-ops will be returning to their core premise with the provision of contracted GP services to member GP-registered patients and the advising of all other requests (including dental and all other non-GP requests) to seek solutions elsewhere,” according to the letter.

“We cannot see how we can any longer accommodate the increasing numbers of patients who have been unable to register with a member GP.”

The letter was signed by the medical directors of all co-ops nationally, on behalf of their members, with the exception of Caredoc.

The plans would essentially see GPs at co-ops nationally working closely to the terms of their GMS contract.

GPs who hold GMS contracts with the HSE are obliged to put in place arrangements to ensure their patients can be seen by them or another doctor during the evenings and overnight if they require urgent care. They are not contracted to provide care to patients who are not registered with a GP.

In the letter, the Association outlined the many concerns of its members, which are leading to “significant clinical risk”.

“We wish to express significant concern that the increase in demand coupled with the spillover from daytime general practice will result in patients being directly referred to [emergency departments] or enduring increasingly long waits to be seen.

“We cannot stress it enough that this is a very significant safety concern for both in-hours and out-of-hours and is a significant clinical risk.

“We urgently request a forum to discuss co-op services with you, as promised more than once by Minister Donnelly.”

GPs are also concerned about the increased demand that the introduction of doctor visit cards for children aged six and seven will have on OOH services. Since 2014, the number of children under-six accessing the service has risen by 48 per cent, the letter claims.

MI understands the planned actions have yet to be initiated, but could be introduced in the coming months.

Ms Arlene Fitzsimons, Operations Manager at NEDOC, told MI there was an onus on the HSE to respond to GP concerns regarding OOH care. Of particular concern is the impact on acute cases, who may wait longer to be seen because of the high volume of “routine” cases presenting. She said the extension of GP visit cards would increase demand on daytime services, which would “spillover” into OOH services.