An out-of-hours service for north Dublin begins today but it can't solve all the problems. Theresa Judgereports
A new urgent out-of-hours GP service for north Dublin will not have any impact on the number of people waiting on trolleys in hospital A&E departments, the interim medical director of the service has stressed.
Dr Mel Bates says he is concerned that expectations will be raised about what the service can do.
"The people waiting on trolleys are all seriously ill and they need admission to hospital. The only thing to reduce the numbers on trolleys is extra beds.
"All this service can do is reduce the number of people who attend A&E inappropriately," he says.
Bates says it is also vitally important that people do not see the D-Doc service, which will be available from 6pm to 8am on weekdays and all weekend, as an extension of the daytime service, otherwise "it will be quickly swamped".
He stresses that it is a service for "urgent" cases only. "If you have people attending inappropriately, there will be longer waiting times for everybody," he says.
D-Doc will start on a phased basis today, and will cover all of north Dublin city and county by December 12th.
A shortage of GPs in north Dublin, which has a population of 500,000, has meant that in the past patients have often found it difficult to find a doctor out-of-hours, particularly at bank holiday weekends.
GP co-operatives such as D-Doc have been running in different parts of the State for some time, with more than 80 per cent of the State now covered, but the north Dublin service has emerged only after lengthy negotiations between GPs and the Health Service Executive (HSE).
Bates, who has a practice in Fairview, says establishing the co-op in north Dublin was always going to be difficult because of the large population and "the chronic shortage of GPs in north Dublin".
There is a total of 230 GPs in the area and half of these are aged over 50, he says.
In north Dublin, the ratio of GPs to population is one to 2,500, while it is one to 1,600 in the rest of the State. The average in the EU is one to 1,000.
GPs have been worried that the new service will not be as good as the arrangements previously in place, Bates says. These varied from practice to practice with many doctors joining colleagues in their areas to offer out-of-hours services or Saturday morning clinics, he says.
A large co-op such as D-Doc will provide a more efficient service than GPs can offer on their own and it also has the advantage of being centre-based, he says.
There will be five treatment centres, in Hartstown (Dublin 15), Swords, North Strand, Ballymun and Coolock as well as a central call centre.
To use the service, patients must first phone (1850 224477) to get either free advice from a nurse or an appointment to see a doctor. Where necessary, home visits can be made as two cars with drivers are also available.
Bates says experience in other GP co-ops has shown that patients are happy to travel to centres for appointments and this enables doctors to see many more patients in a given time period.
Attending a fully equipped centre also means doctors can provide a better service. It has been found that up to 30 per cent of calls can be dealt with by triage nurses giving advice over the phone.
Details of any contact with D-Doc are given to the patients' own GPs the following day.
When the service is fully operational from December 12th, there will be seven doctors on duty at any one time, one at each of the centres and two available to make house calls.
There will also be a nurse and receptionist at each centre and nurses working at the call centre giving advice.
Bates says there is good evidence that this will give adequate cover, providing people use the service appropriately.
Local family doctors will cover most of the shifts, Bates says, although locum doctors will also be used, particularly over the Christmas period. He pays tribute to the HSE for agreeing to fund locums to help cover the start-up period over Christmas and for providing back-up staff, infrastructure and IT.
Of the 230 GPs in north Dublin, some 185 have already registered to take part and more are continuing to do so, according to Bates.
Bernadette Kiberd of the HSE says it is expected that D-Doc will receive some 2,000 calls a week and there will be regular reviews of staffing levels to ensure demand is being met.
She says the system has benefits for GPs in terms of enabling them to achieve a better work/life balance and it will also ensure a better quality and safer service for patients. "The idea of doctors working day and night is not sustainable and it is not good practice," she says.
D-Doc is also good value for money, she says, as the annual cost of €7 million works out at just €15 per head of population in the area.
Dr James Reilly, who has a practice in Lusk, believes D-Doc will provide an enhanced out-of-hours service. People will have a number to ring and a clear idea of where to go when they need a doctor urgently.
He says he also hopes it will make it easier to recruit doctors. "One of the first questions you get asked at interviews is about your night arrangements - young doctors are not interested in doing night duty," he says.
A Fine Gael candidate in the next general election, Reilly says the basic problem is that we are not training enough GPs.
Of the 800 places in medical schools, just 310 are open to Irish candidates with the rest going to non-nationals who pay full fees.
Meanwhile, GPs are coming here from South Africa and eastern Europe.
Reilly is currently looking for a doctor to join his practice and the two doctors he is interviewing are from South Africa and Poland.
He says D-Doc is a "win-win situation for doctors and patients" but there is an underlying manpower issue that has to be solved.
Reilly also says that an out-of-hours GP service cannot change the number of A&E patients waiting on trolleys for admission to hospital.
D-Doc (1850 22 44 77) starts today, November 28th, in the Dublin 15 area with a centre based in Hartstown; in north county Dublin and north inner city (centres at Swords and North Strand) on December 5th; and will extend to all of north city and county on December 12th with centres opening at Coolock and Ballymun.
It is stressed that these are not walk-in services; appointments must be made by phone. It is free for medical card or GP visit card holders.
All this service can do is reduce the number of people who attend A&E inappropriatelyDr Mel Bates