Lack of Garda clearance for locums

ONLY two of the countries nine GP co-operatives require Garda clearance for locums staffing their out-of- hours service, and seven areas of the country are without any out-of-hours service.

Dundalk, Limerick city, Sligo, Tallaght, Tullamore, Moate and Edenderry remain without an out-of- hours service 10 years after the initiative first began.

A national review of the GP-operated service by the Health Service Executive (HSE) found wide variations in how co-operatives are run and reimbursed, including:

* Massive variations in the charge for a telephone triage service, depending on whether the calls are answered by nurses or doctors.

Where nurses take calls, the charge is €4.35 per call, where triage is provided by GPs, the charge per call ranges from €8.43 to €20.32, an increase of 367% on the lowest rate.

* No standard service level agreement between the HSE and co-ops to ensure consistency in quality and standards.

* No standard approach to the recruitment of locums, with different qualifications required by different co-ops. SouthDoc’s ‘red-eye shift’, for Cork and Kerry, is staffed solely by locums who operate the service between 11pm and 8am Monday to Friday and 9pm to 9am at weekends and bank holidays.

* NowDoc (Donegal area), D-Doc (for Dublin), WestDoc (Galway), SouthDoc and NeDoc (north-east) do not undertake Garda clearance while Caredoc (covering areas in the south-east) has Garda clearance as an employment requirement.

The review, which highlighted the fact that the service costs €107 million a year to run, found there were almost one million contacts with GP out-of- hours services in 2008 and that patient satisfaction is rated at over 90% for the majority of these.

SouthDoc treats the most number of patients at treatment centres, but it has the highest number of treatment centres of any co-op – 23, compared to the next highest number of 12 centres in Caredoc.

SouthDoc also carries out the highest number of home visits (more than 25,000 out of total of 186,000 plus calls). However, Caredoc takes the highest number of calls nationally, at more than 212,000.

The out-of-hours service is a lucrative one for doctors; €124 on average per house call before midnight and €162 thereafter.

The review also found that doctors earned €18.76 million treating non-medical card holders, income “retained wholly by GPs”.

The report recommended that in future, the HSE take account of the non-GMS (general medical services) income GPs earn (ranging from €60 to €100 per patient) when awarding future grants. This has not been the case to date.

Among the report’s 13 recommendations are that the out-of-hours service should be extended to cover all parts of the country; the introduction of a standard contract between the GP co-ops and the HSE; nurse telephone triaging only; all payments to GPs to go through a secure online system via the HSE’s Primary Care Reimbursement Service rather than the manual system currently in place.

“In conducting this report the HSE is seeking to ensure the future provision of a high quality GP out-of- hours service for patients. When a mum has a sick child at 2am in the morning, she needs to know that there is a GP with the necessary expertise, equipment and experience that she can call on for help no matter what part of the country she is living in and what her personal circumstances are,” said Dr Joe Clarke, HSE GP unit adviser.