Children under six ‘being referred too often to A&E’

The number of children aged under six referred to emergency departments (ED) by their doctor has jumped dramatically, and as much as 55% at one large GP co-op, according to its medical director.

Dr Gary Stack, of SouthDoc, an out-of-hours service in Cork and Kerry, said the finding was both “unexpected and shocking”. He attributed it to “GP burnout”.

“GPs are now so busy, both in-hours and out-of-hours, that they are no longer in a position, or have the time, to put in that extra bit of work to, for example, review the patient later on that evening, and they take the less risky option of referring,” he said.

This “over-workload” was compounded by a separate, 10% increase in the numbers of over-sixes seen out-of-hours in the same period.

Dr Stack said the increase in patients over-six was likely due to waiting lists caused by patients’ inability to get same-day appointments, because of the increased day-time workload with the under-sixes.

An audit found a 25% increase in the under-sixes’ contact with SouthDoc, compared to the period prior to June, 2015, when free GP care was introduced for that age group.

Nationally, 2,283 GPs (or 82%) are providing the service to 367,000 eligible children.

Dr Stack was speaking at the Clayton Silver Springs Hotel, last night, at the second of three public meetings on health reform hosted by the National Association of General Practitioners (NAGP).

He said that free GP care was “detrimental to the under-sixes themselves, as parents lose the ability to recognise, and deal with, minor illness, but, rather, medicalise what is a transient and self-limiting illness”.

In relation to over-referral to casualty, Dr Stack said when he trained as a GP, referral to the ED was “regarded as the lazy way out”.

“We were taught that the ED was for accidents and emergencies, and if a patient required hospital admission for investigation or treatment, it was up to me, the referrer, to figure out what was the most likely diagnosis and to refer to the most appropriate department within the hospital. On discharge, I got a timely letter outlining the in-hospital management and proposed treatment. I had a direct line of communication and knew who to contact, if any problems resulted.”

Dr Stack said they had “never been given an explanation as to why this system was abandoned”.

Dr Stack said a 10-15 year plan for the health service was required, and should be drawn up by a national health forum and backed-up by a Minister for Primary Care. He said it would require €500m annually to increase GP services.


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