GPs in Cork say that South Doctors On Call (SouthDoc), the out-of-hours GP service, is on the brink of collapse in some areas.
GPs who sign up for SouthDoc are already working long hours during the day in their own practices, then have the additional, out-of-hours workload.
GP shortages are forcing people to use SouthDoc for non-emergency appointments.
Some patients are also wrongly using SouthDoc, which is intended for emergency use only, not as a normal GP service.
SouthDoc is divided into different cells. Each cell works its own rota, based on geographic location. All patients phone a central number and are triaged (assessed) by a nurse.
However, according to GP sources, most patients who call SouthDoc are seen, even if it is not a serious illness or emergency.
Visa restrictions on non-EU doctors practicing medicine in Ireland are also reducing the number of doctors working for SouthDoc, especially during the ‘red-eye shift’ from midnight to 8am. On Tuesday night, there was an SOS callout to Cork city GPs to cover the “red-eye shift.”
GPs also say the Government’s expansion of free healthcare, such as the under-six GP visit card, has added more strain.
These issues are combining and so the system is on the “verge of collapse,” according to Cork GPs. The SouthDoc cell in East Cork is one of the worst-affected.
Dr Mike Thompson, who is based in the Midleton SouthDoc cell, says the average GP in East Cork saw 700 patients out of hours last year. This was the most in the entire Southdoc region, which comprises Cork and Kerry.
The shifts an East Cork GP works for SouthDoc are from 6pm to 11pm midweek. Three GPs also work weekend and bank holiday shifts of 9am to 11pm, which is 14 hours per day. GPs who sign up for SouthDoc take on these shifts on top of their hours in private practice.
GPs do not fall under the European working time directive, so this is why they can legally work these long hours.
Dr Thompson says that East Cork Southdoc had 23,500 calls last year. These calls are supposed to be urgent, for patients who cannot wait to see their normal GP.
However, in 2018, 80% of calls seen by East Cork SouthDoc were routine. Fewer than 20% were urgent and fewer than 1% were emergencies.
“We shouldn’t be seeing routine calls. The system is designed for emergency use only,” Dr Thompson told The Echo.
“We have people coming to SouthDoc because they can’t get an appointment during the day with their regular GP.”
There is also a shortage of GPs in the East Cork area. Many people there resort to SouthDoc because they can’t become a patient of a local GP.
East Cork used to have three SouthDoc bases: in Midleton, Cobh, and Youghal. Now, there is just one, in Midleton.
“We can be stuck in the Midleton base. We might struggle to get to people’s houses for an emergency,” said Dr Thompson.
“It’s getting worse and worse; it’s becoming unmanageable. We can’t see 100 people a day. I don’t think it’s a safe service.”
Dr Thompson has seen patients out of hours for non-urgent requests, such as renewing repeat subscriptions and giving injections.
“People are using a community service incorrectly, but I suppose it was never highlighted properly that SouthDoc is supposed to be for urgent cases.”
He says that fewer than 1% of people are turned away from the out-of-hours service.
However, Dr Thomspon is understanding, because he knows many people have no choice but to attend SouthDoc.
“If you rang your doctor because you had a chest infection and they said they can’t see you for two weeks, of course you’ll go to SouthDoc.”
He fears for the future of the system.
“Non-coverage will start to appear, and I suspect it is too late to fix… this is about patient safety. It will get worse for rural people first.”
He also fears that a non-urgent patient will push emergency patients into A&E.
“Who have we displaced? Who will look after Eileen, in Rostellan, who’s had a fall?”
Dr Nick Flynn, a Cork city GP, says the issues with SouthDoc have been ongoing for a long time.
“It is no longer an emergency service. It has become an overflow service [for daytime appointments].”
“There are people who are attending SouthDoc who can’t get a daytime appointment to see their GP. Then, there are patients who just go to the nightime doctor after work [because it suits them]. The public do need to take responsibility.”
The ‘donut model’ of the Cork SouthDoc area is also a reason why the peripheral doctors in Cork County are under pressure, says Dr Flynn.
The empty circle in the middle of the donut is Cork city, while the ring surrounding it is Cork county. “The city is self-supporting. The city doctors are not involved in [covering out of hours] for the peripheral. So the centre is fine; the peripheral is not.”
Dr Flynn mentions that CareDoc, the out-of-hours doctor service, which covers the south-east and Sligo, does not operate like this.
“The doctors in the centre might have to do a shift out of their cell once in a while, which relieves the burden on peripheral doctors.”
“We are at the start of the crisis; these are the first days. It will only get worse, with an increase in the aging population,” said Dr Flynn.
Dr Denis McCauley, chair of the Irish Medical Organisation GP Committee, a trade union for GPs, said that “demand has increased and the availability of locums has decreased, and is particularly acute in rural areas.”
“The HSE commissioned a review of the out-of-hours, which was completed over a year ago, but this has yet to be published.
“In the context of recent discussions on a new GP agreement, the IMO again highlighted the problems with the out-of-hours service, and the fact that it is simply not sustainable to rely on GPs to cover onerous additional shifts on top of their normal working day.”
“We again call on the Government to publish the review and agree a sustainable and suitably funded out-of-hours service.”