Surge in Demand Causing Long Delays in GP out of Hours Services

This week has seen unprecedented demand for GP out of hours services.

In North Dublin there has been a 40% increase in calls to the service when compared with the same period last year.

GPs are reporting increase in demand throughout this week in their daytime surgeries.

The Urgent GP out of hours services is an appointment-based services and while extra GPs are in place to meet “expected” increase in demand the current level of calls is unprecedented.

The HSE have advised patient to book with their own GP surgeries for routine matters as most GP surgeries will be closed on the 23rd of December, Christmas Eve, Christmas Day, St Stephens Day, and New Year’s Day. The HSE are advising people to stock up their home medicine cabinet essentials at the local pharmacy: painkillers – including painkillers for kids, indigestion reWe’re here to give you practical advice on how to mind yourself or your family when you’re sickmedies, cough and cold medicines, plasters bandages antiseptic creams, contraceptives. Etc.

The HSE are also pointing people to their “under the weather” website which has practical advice on a range of common illnesses like colds, flu, ear aches, sore throats and tummy bugs. The information is provided for adults and children and tells you how long an illness should last, what to expect, and what you can do to cope with, and recover from, these illnesses. The site includes a series of videos featuring GP and pharmacists who offer their expertise in dealing with these common illnesses, practical remedies, and advice on when to seek help from either a pharmacist or doctor.

They have also set up a webpage on “stay well this winter”  which points to the services available, highlighting Out of ours  Out of hours, Injury units and their Under the Weather site.

If you are in need of urgent GP out of hours care in North Dublin call 1850224477  but remember, the service is getting unprecedented  demand.

Northdoc 20 December 2017

Northdoc to increase private fees

Northdoc, the GP Company providing the D doc Urgent GP out of Hours service is set to increase consultation fees by €5 for OOH consultations and €10 for urgent home visits – GMS Medical card holders are not affected.

A recent meeting of the board of Northdoc decided to increase private fees. Consultation fees will increase from €60 (unchanged since 2006) to €65.00 for patients attending the DDoc centres and the home visit fee will increase from €80 to €90. About 5% of home visits are to private patients.

Private fees represent approximately 25 % of Northdoc income with GMS Medical Cards/ HSE income providing 75%.

Just under 100 thousand people in North Dublin contacted the service last year and of these, seventy thousand had direct face to face GP consultations.

GP referral rates to A&E were in the region of 7% of all consultations.

GPs arrange less than 1% of patients to be transferred to A & E by ambulance.

Northdoc Medical Director Dr Mel Bates said “In the absence of a restoration of the FEMPI cuts, which have had a significant impact on the service in terms of the number of doctors that can be provided this increase is inevitable while we wait on the announced reversal of the financial emergency measures (FEMPI) brought in during the financial crisis.”

The HSE rely on Northdoc to provide medical governance and oversight to ensure the best quality of care is provided in the DDoc service. There is a cost to this and the HSE make no contribution to it. In order to provide this the company rely entirely on private fees. There are significant costs in terms of clinical oversight.”

Northdoc outperformed 15 UK and Irish Out of Hours Urgent GP services under clinical learning and continuous improvement of patient safety throughout the organisation. The studies were carried out by the MPS the medical protection society U.K. (For more see here)

Dr Mel Bates said “Our focus is on patient safety – This depends on the quality of our GPs and the ways in which we provide support. We have a comprehensive doctors’ handbook which covers challenges specific to out of hours where normal daytime supports are absent. We also have an anonymized audit system for clinical notes (Clinical Notes Assessment) where we can audit and feedback to GPs on the standard of their clinical notes”.

MPS also noted that Northdoc were the first company in Ireland to get the International Social Enterprise Mark for their work and member GP services, especially with marginal groups such as the homeless in North Dublin.

Dr Bates said that it was with great reluctance that the new fees were being introduced but in order to maintain the quality of the service and in the absence of FEMPI reversals the company had no choice.

Under sixes will impact capacity during clinical winter – especially as holiday season approaches

Under sixes will impact capacity during clinical winter – especially as holiday season approaches.

Presentations in the D-Doc out of hours service for children under six has increased by 25 % year on year to the end of October 2016. However, this does not really demonstrate the effect the under six presentations have, especially during holiday weekends are indeed Christmas and New Year.   The October bank holiday was 38 % ahead on Under Six presentations when compared with 2014 before the scheme was introduced.

Last January there was a lot of media coverage regarding the effects the under sixes were having throughout the health service. Paul Cullen, reporting in the Irish Times said that hospitals had seen a sharp increase in referrals since the introduction of free GP care for under sixes. In Cork emergency medicine consultant Dr Chris Luke said that he had seen a substantial increase in attendances among young children since the scheme was introduced and also said that local GPs in the south had seen up to a 60% increase in young children attending local GP Co-op’s.

In D-Doc in North Dublin, under sixes now represents about 1/3 of all presentations in out of hours. If trends continue, there will be considerable pressure on both A & E and the North Dublin D-Doc GP out of hours service.

Dr Mel Bates, medical director, said that “A 25% increase over the full year to date would indicate that we may expect another spike over the Christmas period. We will be under severe pressure to manage. We have, as ever, more doctors in place during the busy holiday period but we have a finite source or GPs and appointments, and capacity is likely to be reached. That will bring a real challenge both to ourselves and our colleagues in A&E.”






Patient survey shows D Doc as being an expected and essential part of GP care to North Dublin Patients

Patient survey shows D Doc as being an expected and essential part of GP care to North Dublin Patients

Now in its 10th year of operation the D-Doc service continues to score well with patients in the latest Northdoc survey. Patients were surveyed about their experience throughout the patient journey in D-Doc, from the call answering stage, through nurse triage, and on to the experience they had in the centres and with GPs.

98% of respondents said that the calls were answered promptly, found the call takers courteous, the triage nurses helpful, and rated our centre nurses and staff as excellent. Satisfaction with GP consultations was high.

There is a significant evidence that the service is being used on a regular basis by patients. Only 22% of patients use the service just once in a 12 month period, 40% had use of twice or three times, and 38% indicated that they used the service four times more in one 12 month period.

When asked how they would rate the service on D-Doc overall there was a 95% satisfaction rating scoring good or excellent.

When asked “how would you rate the doctor consultation in terms of findings and treatment” there was a 90% satisfaction rating scoring good or excellent.

Waiting times in D-Doc were relatively short – with 92% of patients saying they were seen in under 30 minutes with the remaining 8% been seen in less than one hour.

The results show that there is a definite trend towards treating the service as a ‘convenience’ rather than just for the “urgent” out of hours GP care it was originally set up for. shutterstock_132413564(1)D Doc stats have shown a year on year increase in attendances with particular pressure at holiday weekends and over the Christmas and New Year period. The survey  was conducted in March and include patients seen during preceeding busier winter months.



Minister, Consultant, and GPs Agree free service needs proper resources before expansion of under Six GP scheme.

“Political decisions have real world implications very very quickly” – A & E consultant Dr Chris Luke

D Doc saw a 58% increase in under six consultations in January.

Minister for Health Leo Varadkar said on RTE Tuesday that “you have to have the capacity in the system” in order to expand the free GP care to all age groups.  The minister said that currently the system would be short “about 500 GPs” to provide such a service. On the same programme Dr Chris Luke, consultant in emergency medicine said that has been a significant increase in the number of under sixes attending A & E’s across the country. Dr Luke said that “inevitably there is going to be competition of resources…you can’t look after two patients at the same time, you can look after the toddler or the eighty  year old on the trolley, you can’t look at both simultaneously”. Dr Luke said “Political decisions have real world implications very very quickly”

Dr Gary Stack, Medical Director of South Doc which covers the largest geographical area covering cork and Kerry said that they have experienced a huge increase in demand with a 46% increase in October. “There is less time in which to see patients and there are increased waiting times which can adversely affect the outcome for the patient who needs more urgent care”.

Dr Mel Bates, Medical director for D Doc which covers North Dublin said of the new demand created by free GP care to under sixes. “I don’t think anyone expected it to become as big as is has become”. Dr Bates referring to the minister’s comments said he “welcomed the fact that they are reflecting on the extra workload that had occurred”. Dr Bates said D Doc saw a 58% increase in under six consultations in January. Here is what the minister and Dr Bates had to say…

D Doc Urgent GP out of hour’s service copes well during busy holiday period.

D Doc, like all other health services, saw a surge in activity over the holiday season. During this peak period from Christmas Eve and New Year’s Day the service received over 3000 calls. Over 80,000 call were received by the service in 2014.
Dr Mel Bates Medical Director for D doc said “Christmas and New Years are the most challenging time of the service. We had over 100 individual GPs on duty during this time and they saw over 2500 patients. 70% of the GPs on duty were local north Dublin GPs with the remainder sessions filled by our regular sessional GPs.
Our five centres were extremely busy, especially at Swords, Coolock and Hartstown, but with the help HSE D Doc staff; Receptionists, nurses, and drivers, we managed to provide a safe and good service for patients. Average waiting times from appointments to consultation time were good with 87% seen within 45 minutes and the figure for those seen in less than one hour is 96%.The average waiting time was 27 minutes.home-image
The appointments based system we use means that people can wait in their own homes rather than waiting rooms until their appointment time, and while they could wait up to 4 hours for a routine appointment, we would schedule more urgent cases to be see more quickly.
At lot of planning goes into this achieving this performance. We work with the HSE management and Clinical Nurse Managers as far back as September and of course we have to recruit the local doctors to make themselves available during the holiday period.
We expect levels of activity to remain high over the next two months and would advise people to plan to see their own GP in the first instance before considering D Doc. This way the service will be better available for those people needing urgent GP care during the coming winter months.”

Ebola Virus

In response to concerns about the spread ob the Ebola virus the HSE have issued a FREQUENTLY ASKED QUESTIONS guide which you can access here.  Should are concerned about having been exposed to the virus you can call us on 1850224477

If you are a GP and a member of Northdoc log in to the doctors section here.








New Northdoc website supports GP in Out of Hours setting

The new Northdoc website is designed to provide support for GPs in the D Doc Out of Hours setting.

The information is as simple as “Things to remember on your D Doc” shift to guidelines on more complex areas such as Mental Health issues, drug seeking behaviour, paediatrics and Anti-biotic prescribing. There is a section on Special Patient Groups such as the Traveling Community,, Victims of assault, child abuse, pregnancy related issues, unaccompanied children and much more.

The site provides a handy A to Z of its content and a search option by subject.

Links to useful GP sites, poisons information, Medical council, ICGP, Statutory forms (Mental Health). HSE, MIMS, Univadis, Dermet, and GP notebook.

There are useful section in “Avoiding complaints”, “Informational outcomes” and a host of similar headings.

The site was designed for it to be easy to give on the job feedback to Northdoc via an on online feedback form that generates emails directly to the CEO and Medical Director. There is also easy access to the Northdoc roster website.

There is a public version of the site as well which gives basic information about the service but does not allow access to the GP area of the site.


IMO to permit GP contract facilitating free healthcare for under-sixes

The agreement reached between the Department of Health and the Irish Medical Organisation clears the way for the drawing up of a new GP contract for family doctors, to include the Government’s plans for free care for under-sixes.However, there was no indication last night when talks might begin or even whether they would take place at all. The issue is likely to be discussed at today’s meeting of the Cabinet subcommittee on health, which is also expected to discuss proposals to take the heat out of the medical card controversy.

Minister of State for Primary Care Alex White yesterday welcomed the agreement with the IMO which sets out a process for engagement on publicly funded contracts involving GPs. After months of stalemate, the IMO agreed last month to enter “talks about talks” with the Department of Health. These resulted in yesterday’s agreement.

This deal is separate from the settlement of litigation between the IMO and the Competition Authority, which was announced yesterday, though this agreement also helps clear the way for substantive discussions to begin again between the IMO and the department……

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Hundreds of promised jobs in mental health services not filled

Hundreds of positions pledged for community-based mental health teams last year have still not been filled, latest figures show.The numbers come at a time when campaigners warn that psychiatric services are under heavy strain as a result of rising demand and staffing gaps. In December 2012, the Government announced that €35 million would be invested over the following year in appointing 477 staff to community mental health teams for adults, children, older persons and other services.Figures for the end of March 2014 show just over half – or 267 – of these promised posts have been filled, while a further 26 have agreed start-up dates.

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