A thread, some numbers / facts.
My GMS contract states I shall be on call 24/7/365 to attend to GMS pts - at a surgery their home, hospital or anywhere.
No distance limit btw.
I am a fulltime member of Southdoc since it started in 2005 in East Cork.I believe in it.
I need it!
2/ GPs pay annual stipend of โฌ4800 and work our shifts (i did more than 200 hours last year).
Average GP in east Cork saw >700 pts OOH last year (most in ENTIRE Southdoc region).
X2 GPs midweek (6pm to 11pm) and x3 on at weekends, Bank hols etc (9am to 11pm -yes ,14 hours).
3/ All , obviously, "after" our day job finishes.
We had 27 whole time equivalent GPs in 2005.
We have 33 in 2019 - increase of 20%.
1192 shifts to be covered in the year.
36 shifts each.
GPs, as independently subcontractors, are not under Eurovision WTD.
4/ in 2005 we had x2 drivers and a nurse.
In 2019 - 1 driver and no nurse.
In 2005 we had x3 bases - Midleton, Cobh and Youghal.
In 2019 - just Midleton.
In 2005, STC (GMS fee) for houscall to Youghal - โฌ102.
In 2019 - โฌ42.
5/ in 2005 East Cork population was 41,000.
52 Private Nursing beds.
In 2019, population is 62,000.
Will be 84,000 in 2026 - x100% increase.
Current Nursing Home beds- 298 & 62 more next year - 600% increase.
6/ Not including 3 comm Hospitals and 3 long stay psycho-geriatric units.
50 more beds here next year too.
HIQA founded in 2007, btw.
7/East Cork Southdoc (ECSD)saw 23,500 calls last year.
Calls deemed "unable to wait until your GP is next open".
Urgent, in other words.
Last year - >80% of calls seen by ECSD were classified as ROUTINE.
<20% urgent.
<1% emergency.
?appropriate use of a community resource
8/ No GP in East Cork is taking on new patients.
Huge pressure on appointments as it is.
So, pts cannot access GP - waits for Southdoc. To see same GP! Same Tired GP!
Southdoc is the only thing preventing a GP crisis.
Good for patients.
Good for the HSE / politicians.
9/ Not so good for GPs though!!
We cannot attract GPs to East Cork.
194 GPs graduated last year in the State.
We need double it to ease pressure.
More to help with population increase.
More again when looming retirement of GPs hits us.
Many are emigrating. Good luck to them.
10/ huge factor mentioned is OOH commitment- which is likely to increase!
Not family friendly.
Huge indemnity implications too.
East Cork is beautiful! Coastal, great shops, restaurants, schools, sporting clubs, 20 mins to city / airport / 3rd level /5 large referral hospitals.
11/ Lovely people.
My people (born and reared here!).
They deserve decent, prompt daytime office based GP service and a good OOH service when needed.
I love my job. Wouldn't want to do anything else.
12/ But OOH has become a routine service. Increasing pressure. Increasing numbers.
Not what it was designed for.
Vicious circle. Ever tightening circle.
More numbers, less time, more mistakes.
More fear from GP.
Thus,less likely to work here.
13/ ALL GPs in East Cork wrote to our 2 TDs and 11 councillors in 2018 about this crisis.
โ 1 TD and 3 councillors repliedโ
Speaks volumes.
Wrote to HSE also.
Promised extra help at weekends. Not happening.
Remember - โฌ4800 paid by each GP, each year for red eye cover.
14/ So , over โฌ2million paid by GPs in 1 cell to keep an overnight service for our pts since 2005.
Recall FEMPI? GP HSE fees cut by 38% from 2008.
Recent new contract will mean by 2022 we will see restoration back to just 94% of 2007 figures.
15/ Don't forget about increased:
medical complexity,
survivorship,
demands,
litigation,
specialisation,
consultation rates,
mandatory CME requirements
etc etc since just 2005.
16/ My conclusions ?
Are mine and mine alone, of course.
OOH is going to implode.
Slowly at first, probably in other ,more "rural" cells initially - Macroom cell has only 7 members!!- but then rapidly.
The city will be ok - enough GPs and nearby hospitals to cover.
17/ I suspect it's already too late for many "outlying" cells.
We will see rolling closures of centres.
Many will close for good.
Longer distances to travel for pts.
More pressure on existing cells. Accelerating demise.
18/
95% of consults I see, I manage.
Same for my colleagues.
No referral onwards.
Low tech, timely, patient centred with a local, friendly ( I hope!) GP.
High patient satisfaction.
VERY cost effective (โฌ42 gross , remember) for HSE and taxpayer.
19/ Rural communities will not fund / support a private walk in clinic ( the ones picking the low hanging fruit imho).
So, for example, the 23,500 pts seen last year in east Cork Southdoc will attend either ED (๐ง๐ง๐ง) or wait to be seen by their GP (we have no capacity either!).
20/ Solutions ! (no good just bitchin')
Retain graduates
Rapidly โฌ๏ธ of GP trainees places
Retirement management
Renumeration of current GPs
Reappraisal of OOH services
Retraining public perception of OOH
Realisation GP is cost effective by HSE
Restructure HSE budget to community
21/ Or you'll miss it when its gone....
@roinnslainte @IMO_IRL @SimonHarrisTD @gpbuddy @ICGPnews @GpTrainees @IMT_latest @irishmednews @Irish_health @HIQA @IHCA_IE @DonnellyStephen @Paschald @FineGael @fiannafailparty @IrishTimes @irishexaminer @MPSdoctorsIRE @MedisecIreland
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