'A sense of fear and dread': Cork GP says out-of-hours service is over capacity

GPs operating within SouthDoc have raised concerns about capacity issues within the out-of-hours service in Cork which they said is no longer being used for what it was intended.

Midleton-based GP Mike Thompson said that there are three problems that are leading to the service being used incorrectly by patients which are “people who have no GP, people who won’t wait to see their GP and people who can’t see their GP”.

“80% of the time it is inappropriate calls, and that’s SouthDoc’s own figures, so now the situation is that we are so busy seeing a lot of stuff that can wait or maybe can’t get into their own GP during the day in fairness to patients that we now cannot see the stuff we were designed to be set up for so the elderly, the housebound the palliative care, the nursing homes,” he said.

He said that “at the moment there is no capacity in SouthDoc” and that seeing 20 mildly sick children who he will not be able to do a whole lot for “displaces capacity”.

“You can only stretch an elastic so far,” he said.

Dr Thompson said that part of the service agreement is that triage should be done by triage nurses but that there is an argument to which he subscribes to “that it returns back to GP triage”.

“And unfortunately, 80% of routine stuff is told to wait for your GP or do whatever you want as in you can attend a walk-in service or an emergency department but that’s not going to be too clever for emergency departments who are already under pressure.” 

He said that when seeing those with trivial illnesses, he is fearful about what could be “going toxic somewhere else” and that it is “very frustrating” for him to know there is someone elsewhere in the county who, for example, is at end of life care and who he cannot get to as soon as he should as he has to “wade through eight or nine trivial self-limiting illnesses”.

“So when you have a resource who should oblige to its best ability and best capacity and so people will be hearing the word no a lot more and that may drive them into private health, that may drive them into hospital, we don't know but until we fix day time, out of hours is worsening the situation at the moment.

“Something must be done and the only people who will do it are the GPs. No offence to patients or the politicians, they’re happy with the scenario. It’s not a safe scenario at the moment.

“Every time I go into SouthDoc it is with a sense of dread and fear about what is going toxic somewhere else while I am seeing lots of calls who for whether of convenience or capacity couldn’t be seen by their own GP during that day, and I’m one of those GPs, and that’s the way,” he said.

Dr Nick Flynn of MyCorkGP said that SouthDoc has become an overflow for the day time service and that in order for the service to be delivered correctly there needs to be a way of telling people they shouldn’t use the service.

“Our contract states that the out-of-hours payments that fund it should be paid for consultations which by their medical need can’t wait for the next 9am to 5pm session with their doctor but we all know that’s not what’s happening because people are using the service out of convenience.” Echoing Dr Thompson’s comments, he said that there needs to be a triage system in place.

“My understanding of SouthDoc’s service level agreement with the HSE is that everybody will be offered an appointment. If that is correct, therein lies one of the problems because it should be possible to triage patients into the next day service.

“In order for a scarce resource to go as far as possible for the people who need it most, the people who don’t need it shouldn't use it.

“There’s a whole patient education piece around the use of the out of hours service and who goes to it and how to use it and then if we can peel that back well then we will have more judicious use of the service and can ensure that those who need it can get it to where they need it.

“At the end of the day the patient is the arbiter of whether the issue is urgent and cannot wait until the next day. GPs and patients need support in safely identifying patients who can wait until the next available daytime GP appointment,” he said.

SouthDoc has been contacted by The Echo for comment.