Sharp drop in ShannonDoc’s patient response times

SHANNONDOC has defended its service after official figures confirmed a drop in patient response times from last January to February when it treated almost 1,000 fewer patients.

Figures obtained by The Clare Champion from the HSE through the Freedom of Information Act revealed 6,069 urgent and routine cases were seen by Shannondoc last January, which dropped to 5,074 a month later.

In spite of seeing 995 fewer patients, 1,226 patients were seen within 30 minutes in January compared to 573 in February – a drop in percentage terms from 20.20% to 11.29%; 2,894 patients were seen within an hour in January compared to 1,685 in February – a fall from 47.68% to 33.21%; 4,403 patients were seen within 90 minutes in January compared to 2,780 a month later – a decline from 72.55% to 54.79%.

The number of patients seen within two hours totalled 4,771 in January compared to 3,588 in February – a drop from 78.61% to 70.71%; 5,225 patients were seen within two and a half hours in January compared to 4,151 a month later – a drop from 86% to 81.81%.

The HSE stated the figures of 6,069 and 5,074 are cumulative based on the total number of patients that received a doctors’ consultation in January and February 2022.

Overall ShannonDoc income jumped from €7,306,717 in 2019 to €8,032,116 in 2020, according to their company accounts for 2020.

This included income in 2020 from HSE Out-of-Hours €4,639,883; HSE Specimen Collection: €258,319; HSE SATU €49,275; HSE Methadone clinics and psychology services income: €176,297; HSE Other Income: €92,940; members’ contributions €654,433 and private patients’ income €154,384.

2022 marks the 20th anniversary of ShannonDoc’s foundation in Clare. Since its foundation, ShannonDoc has treated about 700,000 patients from Clare and on average treats more than 30,000 patients annually in the county.

The out of hours service provides cover for patients for 6,400 hours annually. ShannonDoc stated its board are extremely proud of this service to the people of Clare over the last 20 years.

In a statement issued to The Clare Champion, the Reinstate ShannonDoc Committee expressed concern about response times and asked is the delay in reaching patients a staffing issue or is it because doctors covering the service are providing cover in Limerick and Tipperary as well in this borderless service the out-of-hours GP co-op now operates?

ShannonDoc is an urgent out-of-hours GP service for patients that cannot wait to see their own GP. ShannonDoc operates strictly by appointment only and is not a walk-in service.

All patients that require an appointment with a doctor will be given a same day appointment. It is not an emergency service.

In line with its Service Level Agreement (SLA) with the HSE and with best practice set out by the Irish College of General Practitioners (ICGP), the requirement is that 98% of urgent cases are given an appointment within two hours of clinical assessment and 98% of less urgent cases are given an appointment within six hours of clinical assessment.

ShannonDoc confirmed it is in full compliance with the requirements set out in the SLA with the HSE.

Last January and February, a total of 99.78% of total patients received a doctors consultation within the required response times.

According to ShannonDoc figures, the average patient times for urgent and less urgent patients was 51 minutes in January and 65 minutes in February.

It stated the average length of time it takes for a patient to be treated by a doctor is well within the required best practice response times; averaging 37 mins for urgent patients in January and 49 minutes in February.

Less urgent patients had an average wait time of 57 minutes in January and 73 minutes in February.

Additionally, due to the appointment based system in place; patients are treated according to their appointment times without having to wait long periods of time in a treatment centre to be seen by a doctor.

A recent review of operations over the weekend from May 14 to May 15 demonstrated that the operational capacity was more than sufficient to deal with patient demand in all regions.

ShannonDoc outlined 85 Clare patients were treated from 10am to 10pm during this period, which was 52% of average capacity; six Clare patients were treated from 12 am to 8am, which was 20% of average capacity.

Figures released through FOI for the number of GP’s actively participating in ShannonDoc have remained pretty constant in recent years.

There were 68 Limerick family doctors in the co-op in 2017, this increased to 70 in 2018, fell to 68 in 2019 and totalled 67 in 2020 and 2021.

In 2017, there were 48 Clare doctors providing out-of-hours cover, 47 in 2018 and 2019 and 46 in 2020 and 2021.

In North Tipperary, the respective figures were 27 in 2017, 28 in 2018, 30 in 2019, 29 in 2020 and 28 in 2021.

The Reinstate ShannonDoc group recalled it was told by ShannonDoc management there was a shortage of family doctors in Clare when they started campaigning in 2016.

“This shortage of GPs coupled with an inability to attract locums due to visa issues, was making it difficult to provide a full service in the county. These were the excuses used to justify the scaling back of the out of hours service in the county at the time and to close the centres at Kilrush, Killaloe and Ennistymon.

“If ShannonDoc didn’t have a shortage of GPs, why was it taking its longer times to see fewer patients as HSE response times indicate?

“County Clare has a high dependency on the out of hours service due to the lack of any other form of out of hours care and the very serious levels of overcrowding at UHL.

“The group would like to believe that ShannonDoc will reopen the centres as they suggest, that has been the main objective of our campaign to see those centres reopened and properly staffed, providing a full out of hours service in Clare but it is my understanding that nothing has changed in relation to staff shortages. The figures in the FOI are a gross exaggeration of the real situation. There is still a very heavy reliance on locums to keep the service afloat.

“We are disappointed that ShannonDoc has decided not to come before Clare County Council to answer questions.

“They certainly have a lot of questions to answer. They are funded by public taxes we need to ensure public accountability,” the group stated.

In an effort to address the growing shortage of GPs in the Mid-West; over the last 18 months ShannonDoc embarked on a new initiative to directly attract and employ new healthcare professionals including doctors to work primarily in the out of hours service.

Since the strategy commenced, the group have been successful in bringing in and employing 15 new full time doctors into the region.

These doctors have established themselves in areas all across Clare, Limerick and North Tipperary.

The company is committed to continuing this ambitious recruitment plan, which represents a significant investment by the company to ensure the out of hours service remains sustainable for the future.

Mid-West Community Healthcare advised ShannonDoc’s service remains the same as was provided pre-Covid 19.  However, the model of service delivery is slightly different in that the GP may not always be present in the Treatment Centre but will be available to patients as required.

The HSE has received the relevant monthly Patient Assessment and Response time reports for January 2022 and February 2022.

In January 2022; 99.87% of patients were treated within the required response times and in February 2022; a level of 99.66% was achieved. The required level that needs to be achieved as per the SLA is 98%.

In total, there were 25 cases that were outside of the required response times.

There are many reasons why patients may not receive an appointment within the required response times such as patients not arriving on time, doctor already busy on house calls and appointment capacity reached during peak time etc.

It has been confirmed by ShannonDoc there were no clinical complaints as a result of any of these cases.

The HSE are satisfied that ShannonDoc are meeting the response times as specified in the Service Level Agreement (SLA) and can confirm that ShannonDoc have not received any complaint in relation to response times.

In many instances the response times of ShannonDoc have been ahead of the expected timeline for urgent and routine calls as outlined in the January ‘22 and February ‘22 data.

The HSE can also confirm that ShannonDoc have a robust structured framework process in place which provides an annual patient satisfaction and evaluation survey, quarterly evaluation of response times, statistical data on numbers of calls, call types, demographical locations and time of consultations are submitted annually and intermittently as requested.

Complaints statistics are provided as required.

Performance metrics are also submitted to the HSE on a weekly basis. These performance metrics include quantitative data and are monitored by the HSE on a weekly basis.

The HSE have quarterly SLA meetings with ShannonDoc where all performance related data is reviewed to ensure compliance with the Service level Agreement in place.