Bid to involve GPs in reducing gynaecology list fails

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An attempt to involve family doctors in reducing long waiting times for women with a distressing gynae- cological problem has failed after GPs said that they were not prepared to take on additional unpaid work.

In an email to GPs last week, Cork University Maternity Hospital (CUMH), said due to “long waiting lists for patients with prolapse [prolapsed womb], we are looking at moving towards the HSE model of integrated care” — with both hospital and GPs playing a part.

It would involve GPs fitting a pessary, a device to shore up a prolapsed womb. To train for this role, CUMH invited GPs to attend a masterclass in pessary fitting — at a cost of €200 per person, made payable to the Cork University Foundation, to fund research.

The email explained that the initiative was against a backdrop of an almost year- long wait for new patients on the pessary waiting-list.

Women with prolapse can suffer from a range of distressing problems, including urinary continence. In extreme cases, the entire uterus is outside the vagina.

GP Mary Favier, from Cork City, said GPs were “absolutely incensed” by the proposal, as they had already been “FEMPI-ed to within an inch of our lives” and yet were being charged by their hospital colleagues to assist in reducing their workload.

She said GPs attending the masterclass would have to hire locums for the day at a cost of approximately €250 and with four GPs in her practice, the cost was heading north of €2,000.

The Irish College of General Practitioners sent a stinging response to CUMH saying the proposal was “doubtless well intentioned” but that GPs “are currently not resourced or remunerated to provide a pessary fitting service”.

“Additionally pessaries are not covered by GMS prescription nor are they supplied by the HSE,” the ICGP wrote. “If your clinic received zero funding from the HSE and you required all patients to bring their own pessary, I wonder how sustainable this would be?”

The response from Barry O’Reilly, clinical professor of obstetrics and gynaecology, head of urogynaecology, CUMH, was to apologise immediately, while continuing to offer the masterclass, but without charge.

“It is obvious that we have failed to appreciate the enormous burden of work that you already perform in primary care,” said Prof O’Reilly. “Whilst our intentions were entirely honourable we acknowledge our misjudgement.”

CUMH was in the headlines last year for what Health Minister Simon Harris said were unacceptably high waiting times for women with gynaecological problems. Additional resources have been provided and progress has been made, with the number waiting 12 months or more down from 1,881 last April to 1,147 as of the end of November.

The overall number on the outpatient list was 3,874 on November 30 last.

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