GP proposal said to keep NowDoc centres open

A prominent west Donegal GP said discussions about the possible reorganisation of NowDoc resources do not include plans to close any NowDoc centres.

A prominent west Donegal GP said discussions about the possible reorganisation of NowDoc resources do not include plans to close any NowDoc centres.

Dr. Anthony Delap, a Bunbeg-based GP, said on Tuesday that plans involve “how to use resources better between midnight and 8 am, but we’re not shutting down anything”.

The GP said he understood that a GP proposal under discussion would see two or three mobile NowDoc units operating throughout the county during what is known as the “red-eye” shift, from midnight to 8 am.

The GP proposal also calls for one doctor on call after midnight in each of five areas: Letterkenny, Mountcharles, Derrybeg, Carndonagh and Ballyshannon, Dr. Delap said. The details of the proposal have not been finalised, he said.

But the doctor said he would oppose any plans to redeploy receptionists who staff NowDoc centres in Derrybeg, Carndonagh and Mountcharles, calling them a “vital cog in the system”.

Meanwhile, Charlie McConalogue, Fianna Fáil TD for Donegal North East, said he still wanted the minister for health and the Health Service Executive to give a clear commitment “that they do not wish to see any diminution of the service currently provided at NowDoc Centres.” He said public concern over the future of NowDoc stemmed from the HSE’s and the department’s “reluctance to be absolutely clear in their commitment to maintaining service levels.”

On the floor of the Dáil on Tuesday night, in response to a question from Deputy McConalogue, Roisin Shortall, TD, minister of state in the department of health with responsibility for primary care, said reduction of service has not been discussed. But her remarks fell short of the commitment the deputy sought.

The minister of state said the HSE West review of NowDoc services follows from recommendations of the 2010 National Review of GP Out-of-Hours Services. She explained that at the annual general meeting of NowDoc Ltd., GP members passed a motion to form a sub-committee to examine viable options for the provision of overnight GP cover.

The GPs will submit proposals to the HSE “to outline how such cover might be provided more efficiently, without compromising patient safety”, Minister Shortall said. The outcome of the GPs’ review is not finalised and no proposals have been submitted to the HSE, she said.

“While changes to service delivery arrangements may be proposed in the future, the issue of curtailing or reducing services has not featured in any discussions to date,” she said.

Deputy McConalogue said elected representatives needed to keep the pressure on to ensure that remains the case. “I know there are financial pressures across all sectors, but the provision of a 24-hour doctor service in all regions of the county is absolutely non-negotiable,” he said.

There were concerns expressed last week over reports that GPs were considering a proposal to run NowDoc services from Letterkenny from midnight to 8 am, with a mobile unit based in the town to respond to other parts of the county.

NowDoc was established 10 years ago in a cooperative structure between GPs and the HSE to provide urgent, out-of-hours medical care in Donegal, south Leitrim and north Roscommon. The HSE provides the infrastructure for the service -- including drivers, receptionists and nursing staff -- and GPs provide the cover for the doctor rotas. The HSE had provided funding to doctors for hiring a locum for the midnight to 8 am shift, but that support was removed about a year ago.

Dr. Delap said proposals to change the NowDoc service delivery overnight are intended to better utilise resources. He said as the system now stands, one centre could have few or no calls overnight, while another could be very busy.

“It’s very fixed and rigid at the moment,” he said.

There are also concerns over a proposal to redeploy receptionists now assigned to NowDoc centres in Derrybeg, Mountcharles and Carndonagh. The proposal would see drivers carry out those duties when they are not taking doctors to calls. However, unless other provisions were made, the centres would have to close for the time they were left unattended when doctors and drivers were away.

HSE officials told Donegal Oireachtas members last week that the

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redeployment proposal was under review with the Labour Relations Council. But independent Cllr. John Campbell said he understood that NowDoc receptionists have been told they will be redeployed in the coming weeks.

“This shouldn’t happen if the issue is still before the LRC,” he said, tabling a motion at Monday’s council meeting that called on the HSE to make clear their intentions.

“The needs of patients or the geography of the county have not changed since NowDoc was set up,” Cllr. Campbell said. “Are they going to tell us that they over-resourced the service to begin with?”

Dr. Delap said he would not favour redeployment of the receptionist staff, saying they are “very important for the smooth running of the service”.

NowDoc surveys show a satisfaction rate of about 95 percent among users of the service. “I think it’s a good service,” Dr. Delap said. “It is especially important for rural Donegal.”