GPs providing care at out-of-hours (OOH) services have warned they cannot continue to work “day and night” and that service expansion is required to meet patient needs.
Speaking to the Medical Independent, Dr Ken Egan, the Chairperson of the National Association of GP Co-ops, said GPs are “flat-out” during daytime practice. He said the introduction of the chronic disease management programme and the increase in the older population are among the factors driving the workload.
In the “old days” of co-ops, he said GPs might see three to four patients overnight. But this had now changed dramatically.
“There is a huge increase in demand at co-ops and the cases are more complex,” said the Mayo GP. “It’s now a health and safety issue to have GPs working day and night.”
Dr Egan said the issue presented a major challenge for the group that is conducting the strategic review of general practice, which began in 2023.
According to the terms of reference set out by the Department of Health, the review is examining the “contractual framework” of GP services. The provision of OOH services is among the many areas it is assessing.
The review group is led by Mr Pat Healy, National Director for National Services and Schemes and includes representatives from the HSE, Department of Health, and a consultancy firm. To date, the review group has met with several, but not all, co-ops nationally.
Dr Egan called for national standards for OOH provision to ensure equity in the quality of services nationally. He said the review team must put forward standards for the distance rural patients have to travel to see an OOH GP, for example. They must also examine how co-ops would link with the HSE and Department of Health in the future.
“Right across the board, co-ops are hoping that the review group will agree to the provision of dentists, pharmacists, mental health and social work staff at co-ops,” Dr Egan added.
Dr Egan said the needs of patients necessitated the expansion of the OOH service. He underlined that co-ops operate for 118 hours per week.
Southdoc Medical Director Dr Gary Stack said the outcome of the review would feed into the formulation of a new GP contract. Before the outbreak of Covid-19 in 2020, a proposal was made that GPs work 100 hours annually at co-ops. However, Dr Egan said the proposal was no longer acceptable following the pandemic and the increased workloads. Dr Stack agreed and stated: “That ship has sailed.”
A HSE spokesperson declined to provide a date as to when the review would conclude, but said engagement with stakeholders was underway.
“The review is examining the issues affecting general practice including GP training, GP capacity, out-of-hours services reform, the e-health agenda, and the financial support model for general practice,” said the spokesperson.
“The review will then identify the arrangements necessary to improve the current system of GP care as part of a primary care-focused health service and in line with the Sláintecare vision on access. Following its conclusion, a report will be presented to the Minister for Health giving an assessment of the challenges affecting general practice and setting out the actions needed to provide for a more sustainable GP service.”
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