New video-link GP service for Kilrush

Plans have been unveiled for the provision of a video-based remote doctor service in Kilrush, as efforts intensify to halt cutbacks in the out-of-hours Shannondoc service in West and East Clare.

It remains to be seen if this will satisfy campaigners seeking a full restoration of GP out-of-hours services throughout the county.

Under a new rationalisation plan, which was supported by doctors at a recent annual general meeting, Shannondoc’s Kilrush and Ennistymon services will relocate to Miltown Malbay during weekdays, with the same operating hours applying. Kilrush and Ennistymon will only now open at weekends until 7pm.

Shannondoc is to introduce a video-based remote doctor service at its Kilrush centre, allowing it to remain open nightly for two hours. The new service provides for a remote doctor to connect with the Kilrush clinic via a secure, high-definition video link. Patients will contact Shannondoc as they normally would and a triage nurse will first determine if the patient requires a GP appointment and then if the patient is suitable for a video consultation.

A nurse based at the Kilrush centre will initiate the consultation by taking the patient’s details and vitals, before the remote GP commences what will otherwise be a typical consultation.

Deploying a high-definition digital camera, digital otoscope and electronic stethoscope, the GP will see and hear all images and sounds in real time, enabling a clinical diagnosis and treatment.

The service will be supported by an on-duty doctor in Miltown Malbay from 6pm to 8am, who can also travel to Kilrush if required.

The system, which is operated by medical services company Mediserve and has been successfully trialled elsewhere in the north-east, will operate from Monday to Friday between 8pm and 10pm.
The initiative was announced after hundreds of people signed an online petition requesting full restoration of Shannondoc’s services, ahead of a public meeting in Kilrush Community Centre this Friday evening at 7pm.  Over 1,700 people have signed the online petition.

The news comes in a week that the Irish Nurses and Midwives Organisation (INMO) described the chronic overcrowding of 66 patients on trolleys in University Hospital Limerick (UHL) as “unprecendented”.

Commenting on the new technology, Shannondoc CEO Mike Finucane said, “We are introducing this two-hour service on the back of very positive results gleaned during trials at Nedoc in the north-east.  It’s a 2016 technology solution to a 2016 rural Ireland challenge”.

We have seen a significant decline in GP numbers in the West Clare area, to the extent that our doctors in this area are working an additional seven weeks per year to keep the Shannodoc service here going.

“This is also only possible through engaging three locums in the Kilrush cell but locums are now in shorter supply for the area.  In the event of not having locums, which is a real possibility, GPs would be faced with having to work four extra months each year to keep the existing service running, which is not sustainable,” he said.

“Essentially, the difficulties we face are two-fold; we have a lack of GPs and rural depopulation over decades means there are also a lot less patients to see.  On Monday night of this week, for example, we had one patient in Kilrush and one in Ennistymon across five hours in each centre. That’s two patients in 10 working hours.”

“The most we had any one night last week was five in Kilrush and three in Ennistymon.  Normally, a GP can safely see 20 patients or more in a five-hour period,” Mr Finucane stated.

“Our particular problem in Kilrush going forward is that we have three GPs retiring in the next 18 months to two years.  It will be very difficult to attract new GPs to the area if they have to commit to these extra hours, not least when their peers in Ennis or Limerick have a lot less out-of-hours service. This technology solution may enable us to overcome that issue,” he said.

No measures have been proposed to date for the service in Killaloe, where Castleconnell-based Dr Blanaid MacCurtain, who is involved in Shannondoc, has expressed serious concerns about patient safety.

“Within the past year, I had a case of anaphylaxis, which arrived in Killaloe from East Clare requiring three doses of adrenaline and other IV medications, before she could be transferred safely to hospital. It is quite possible that a further delay would have had devastating effects.

“It would also appear that while the area covered by the Shannondoc cell has been carved up between Ennis, Limerick and Nenagh, there are in fact no extra doctors covering this area on-call.
“I feel this extra workload will add considerable stress for the doctor on-call, which may increase the likelihood of suboptimal care,” Dr MacCurtain added.

Regarding Dr MacCurtain’s claims, Shannondoc stated it respects the views of all its members with regard to the doctor-led changes due to GP shortages.

“With regard to Killaloe, we were on notice since last year that three doctors were moving to leave Shannondoc unless changes were made to the Killaloe cell. This would have left us with just seven GPs. This number would have made the service untenable, unsustainable and unsafe. In order to counter this in a proactive manner, the current plan was developed and voted on by the Killaloe cell members on three separate occasions. In each instance, a majority voted in favour of the disbandment of the cell.

“This decision is unpalatable for all, our GPs and patients alike, but it is simply not possible to maintain the service that has heretofore been delivered with seven GPs. We absolutely regret this, not least for the inconvenience it causes to patients who up to now have used our Killaloe cell for their non-emergency out-of-hours service,” the Shannondoc spokesman stated.

Minister of State for Employment and Small Business Pat Breen said Shannondoc’s plan to introduce a teledoc would be a welcome interim intervention in dealing with the service’s opening hours issue, if it is deemed safe by GPs.

“The advancements in medicine and technology means we can look at new solutions in treating patients, as long as these new solutions ensure patient safety and care,” he said.

“It is my understanding that a similar service to that being proposed in Kilrush has proved very successful during trials at Nedoc in the north-east of the country.

“If GPs, who are expert in primary care, are confident that this is a viable solution for Shannondoc, then I am happy to see it being tried, as other options are also explored,” added the Fine Gael TD.

“I would also encourage doctors to engage with my colleague, the Minister for Health Simon Harris, on an option of State paid salaried GP posts in rural Ireland, during the GP contract negotiations.

“The issues within Shannondoc are not due to a lack of financial support for the service, but as a result of GP shortages and population decline in areas of rural Ireland,” Deputy Breen continued.

“We must therefore consider alternative options when dealing with the issue, such as the teledoc service and the putting in place of policies that will allow for State supported GPs in rural areas, where the market cannot support one,” he concluded.

Dan Danaher