HSE and health advocates at odds over Shannondoc staffing

UP to 46 Clare general practitioners are participating in ShannonDoc’s out-of-hours services, according to the HSE’s Mid-West Community Healthcare.

The level of cover provided by Clare GPs was queried by the Reinstate ShannonDoc Committee (RSC) recently.

Noeleen Moran of The Reinstate Shannondoc Committee (RSC) claimed there was no GP available in Clare after midnight from January 7 to January 12 inclusive.

In addition to this period, Ms Moran stated there was no doctor in Ennis after midnight on January 4, 12 or 14 either.

“Not alone are centres in Ennistymon and Kilrush closed, centres at Ennis and Miltown Malbay and are not operational on some nights after midnight. The out- of-hours service in Limerick is being stretched to cover the whole of county Clare as well.

Ms Moran said the RSC find it hard to accept there are as many as 46 GPs participating in providing out-of-hours GP care in Clare.

“If this was the case, we would not have such a heavy reliance on locums and the need for Limerick GPs to provide cover in Clare as was the case in January.”

ShannonDoc’s surplus for the 2020 financial year after providing for depreciation and taxation amounted to €742,082 compared to €103,591 in 2019.

Between January 3 to 14, ShannonDoc’s capacity never reached more than 32% of total doctor capacity available from midnight to 8am.An average of five patients in Clare were treated every night between midnight and 8am by one of ShannonDoc’s remote or mobile doctors during this period.

However, ShannonDoc has stated its services were in no way curtailed from January 3 to January 14, even though 30% of its workforce had to self-isolate due to Covid-19.

Sinn Féin Deputy Martin Browne recently tabled a Dáil question asking Health Minister Stephen Donnelly to outline the number of general practitioners currently participating in ShannonDoc’s out-of-hours service in the Mid-West; the number of hours they provide to the service on a weekly, monthly and annual basis in tabular form; the current status of the general practitioner contract and the progress that has been made in relation to the obligation to provide GP out-of-hours care.

In its response, the HSE stated there were 141 GPs participating in ShannonDoc’s out-of-hours service, which includes 67 in Limerick, 46 in Clare and 28 in North Tipperary.

The health authority confirmed there has been no change in the status of the General Practitioner (GP) contract for those GPs who are contracted by the HSE to provide GP services to medical card patients.

It outlined the operating hours for the Ennis treatment centre are 6pm to 8am from Monday to Friday, with an extended opening to 9am on Bank Holidays and Public Holidays.

Shannon is scheduled to be open from 6pm to 11pm from Monday to Thursdays and 9am to 10pm on Fridays, weekends and public holidays.

Miltown Malbay is scheduled to run from 6pmm to 8am Monday to Thursday, 6pm to 9am on Friday, Saturday 7pm to 9am Sunday and Sunday 7pm to 8am Monday.

A doctor may not always be on site in Shannon or Miltown Malbay, but the HSE stated there is a doctor on duty available to see patients when and if required.

ShannonDoc has confirmed that a team of triage nurses, patient care administrators and central dispatchers are available midweek from 6pm to 8am Monday to Thursday and 24-hour cover at weekends and public holidays from 6pm Friday to 8am Monday.

Patients can access the service by calling the new lo-call number 0818 123500 or 061 459500. Every patient will receive a full clinical assessment by a nurse free of charge.

The HSE stated a team of doctors and patient assistants are on duty midweek from 6pm to 8am Monday to Thursday, while 24-hour cover at weekends and public holidays is provided from 6pm Friday to 8am Monday.

If deemed clinically appropriate by the triage nurse, the patient will be given either a face-to-face appointment at one of the ShannonDoc Treatment Centres, a virtual consultation or the doctor will see the patient in their own home.

“In short, every single patient that needs to be seen, is seen and the delivery of a quality clinical care remains the priority.

“ShannonDoc provides urgent GP care only and is not an emergency service. Patients that require emergency services should continue to contact 999 or 112.

“ShannonDoc has a Service Arrangement with the HSE whereby urgent cases should have an appointment within two hours of clinical assessment and less urgent cases should have an appointment within six hours.

“ShannonDoc continues to operate strictly by appointment only and is not a walk-in service.”

The HSE stated an enhanced model of care has been in operation since March 2020 through the introduction of mobile doctors working as a team and has ensured that all areas in the Mid-West are adequately covered by the urgent out-of-hours GP service.

“ShannonDoc’s operating model, which incorporates a team based approach, utilises the doctors, triage nurses and support staff effectively.

“The introduction of mobile doctors, remote doctors and Core Treatment Centre doctors, all centrally co-ordinated by dispatchers and nurses ensure that all areas are covered.

“If a doctor is not present in the Treatment Centre, a mobile doctor will be available to patients as required. Following triage, the doctor will come and see patients in the relevant centre or carry out a home visit or arrange a virtual consultation as deemed clinically appropriate.

“In addition, where there are increased demands in certain areas, support teams can be deployed from other locations providing an overall borderless service and ensuring services are provided where most needed.”

By Dan Danaher