HSE advises everyone to consider Flu Vaccine

The seasonal flu vaccine protects against the 3 strains of flu virus recommended by the World Health Organization (WHO) as the strains most likely to be circulating this season.

You should get your flu vaccination from September to be covered for flu season. The viruses change each year. This is why you need to get a new vaccine each year.

People 18 and over should get the vaccine from their GP or Pharmacist or Occupational Health Department. Younger people should get the vaccine from their GP.

The flu vaccine is free if you are in an at risk group but you may be charged a consultation fee, unless you have a medical card or a GP visit card.

The flu vaccine doesn’t contain any live viruses – it cannot give you the flu.

How it works

The flu vaccine helps your immune system to produce antibodies to the influenza virus. If you have been vaccinated and you come into contact with the virus, these antibodies will attack it and stop you from getting sick.

The flu vaccine starts to work within two weeks.

At-risk groups

We are urging people in at-risk groups to get the flu vaccine. We strongly recommended the vaccine if you:

  • are 65 years of age and over
  • are pregnant
  • have a long-term health condition
  • work in healthcare
  • are a carer
  • live in a nursing home or other long-term care facility
  • in regular contact with pigs, poultry or water fowl

Don’t get the flu vaccine if you have had a severe allergic (anaphylaxis) reaction to a previous dose or any part of the vaccine.

Vaccination should be re-scheduled if you have an acute illness with a temperature greater than 38°C.

For more information click here.


Measles Outbreak in North Dublin

Measles outbreak in North Dublin

The HSE has advised that they are dealing with a Measles outbreak in North Dublin and that 13 cases have been confirmed since July.

Dr Ruth McDermott, public health doctor said: “Measles can be a serious illness and is highly infectious. The best protection is to be fully vaccinated with two doses of MMR vaccine.”

From the HSE website:

People at increased risk of getting measles are those who are not fully vaccinated with two doses of MMR vaccine or have not had measles in the past. The risk of measles remains for up to 21 days after contact with a case of measles.

If you think you may have measles, stay at home and phone your General Practitioner (GP) for advice.

People who are sick should not attend any congregated settings such as crèche, school, work or religious gatherings until they have recovered from illness. Actions taken to prevent further cases:

The Public Health Department has sent information on measles to all Emergency Departments and GPs in Dublin, Kildare and Wicklow to inform them of this measles outbreak.

The Public Health Department gives the following advice on the most effective measures to control the further spread of this potentially serious illness:

Vaccination with measles containing vaccine (MMR):

All children should get the MMR vaccine when they are aged 12 months. If any child aged over 12 months has missed this vaccine they should get it now from their GP.

All children should get a second dose of MMR vaccine when they are 4-5 years old.  This is usually given in Junior Infant Class at school. If a child has missed this second MMR vaccine they should get it now from their GP.

Adults under 40 years who have not had measles or have not received 2 doses of MMR vaccine should contact their GP to get the MMR vaccine.

Measles symptoms include:

High fever


Runny nose

Red eyes

Red rash that starts on head and spread down the body – this normally starts a few days after onset of illness. The rash consists of flat red or brown blotches, which can flow into each other. It lasts about 4-7 days

Vomiting, diarrhoea and tummy pain may also happen.

Measures to prevent the spread of measles if you think you may have measles:

1. Do not go to work, school or crèche or any congregate setting such as shopping centre/cinema etc.

2. Stay at home and phone your GP. Tell the doctor or nurse that you think you might have measles.

3. Stop visitors coming to your house to prevent the spread of measles.

4. Pregnant women who have been exposed to measles should seek medical advice as soon as possible.

Risk of measles from international travel:

There are on-going outbreaks of measles in many countries in the European region and worldwide. Most of the cases in the EU in 2018 were reported from Romania, France, Greece, and Italy. Most people who get measles on holiday do not know they were exposed until they develop disease. Unrecognised exposures to measles have occurred at airports, on planes, at concerts, in shops and health care settings. In 2018, 31 deaths associated with measles have been reported in EU countries.

Advice for people travelling abroad:

Vaccination remains the most effective measure against infection. Children aged 6-11 months of age, travelling to other countries and regions where measles outbreaks are reported, are recommended MMR vaccine. This is an extra MMR vaccine. A dose given before 12 months of age does not replace the dose that would normally be given at 12 months of age.  Please note, if requesting the MMR for babies from 6-11 months to protect them while travelling, the vaccine itself will be free but there will be an administration fee to be paid to your GP for this vaccine (as it is a travel vaccine).”

Older children should be age appropriately vaccinated. Children who have missed their recommended doses should get the MMR vaccine from their GP.

Adults may be at risk of measles, particularly those under 40 years of age who have never had measles or two doses of a measles vaccine.

More about measles:

Measles is highly contagious and is spread easily. The time between exposure to measles and developing the rash is usually 14 days (range 7-21 days). People are infectious from four days before rash starts until four days after.

Complications of measles:

Measles can cause chest infections, fits (seizures), ear infections, swelling of the brain and/or damage to the brain. Measles is a notifiable disease and GPs and hospital clinicians should immediately notify Public Health if they suspect someone has measles. Last updated on: 22 / 08 / 2018

GPs Support Call From Ombudsman for Increased Mental Health Funding

Ombudsman’s report that 2,615 children are waiting to be seen by The Child and Adolescent Mental Health Services (CAMHS).

“a continued failure by public bodies to put the best interests of children at the centre of their decisions.” – Ombudsman.

You can read the original article here and the following is the text of the letter published in the Irish Times on Monday June 18th:

Sir, – We are a group of GPs who practise in disadvantaged areas (deepend.ie), many of us for over 15 years. As GPs working with vulnerable children on a daily basis, we agree with the concerns outlined in the report of the Ombudsman for Children (“Ombudsman calls for increased mental health funding”, News, June 14th).

The communities we work in have a higher prevalence of mental health issues, particularly in children and adolescents, and we are extremely concerned about the current state of services across the whole spectrum, from prevention and early intervention, to treatment for severe mental illness.

The neglect of children suffering mental distress leads to untold damage in terms of education, employment prospects, criminality and future mental health.

There is no recognition of the need for resources to match the differing needs of local populations, leading to marked health inequalities, which can have a profound life-long impact. In many disadvantaged areas, the waiting time for child psychology services is excessive. In some areas, it is now over a year, and in the case of an acutely distressed child, this is completely unsafe and unacceptable.

In the current context of limited child and adolescent mental health services (CAMHS), it is vital that community services be vastly improved and easily accessible.

There is overwhelming international evidence that early intervention reduces future adverse outcomes and we need services resourced to address the needs of our most vulnerable citizens to ensure a brighter future for us all. – Yours, etc,


Dublin 8;


Dublin 8;


Dublin 15;


Dublin 15;




Dublin 5;


Dublin 5;


Dublin 1;




Dublin 1;


Dublin 5;




Dublin 5;


Dublin 11.


Study shows that Free Under 6 GP Care led to a Dramatic Increase in GP visits

“The number of children seen free of charge more than doubled to 10,824 during the year after the policy change”.

. The study published in the annals of family medicine by Dr Mike Callaghan and his colleagues (Department of Public Health and primary care, Trinity College Dublin) has found that offering free childhood general practice services led to a dramatic increase in visits. There was a25% increase in daytime and out of hours visits. The article says that the increase has implications for future healthcare service planning and mixed public and private funded systems.

The study focused on an eight daytime general practice services in the local out of hours services – Northdoc and on a detailed study of the patient use of the Northdoc out of hours service –D Doc.

Northdoc offers urgent general practice services out of hours to the population of North Dublin (pop 550 K). The service covers over 140 practices (250 GPs).

The study showed that 9,898 children aged under six made approximately 15,000 visits the general practice out of hour’s service in the period before the policy change, and 11,890 children made 8958 visits in the period after. This difference the case to a 20.1% more children seen at least once and 25.7% more visits in the latter.

The number of children seen free of charge more than doubled to 10,824 during the year after the policy change.

Dr Mel Bates, Medical Director of Northdoc said “I want to congratulate Dr O’Callaghan and his colleagues for this essential piece of work. The Government and the department of health need to look closely at this report. General practice, both in and out of hours simply cannot continue to expand to meet demand without more GPs in the community and proper funding. ”

You can link to the full article here


D Doc GP out of Hours service up and running but with limited capacity

D Doc GP out of Hours service up and running but with limited capacity.

Northdoc will operate a reduced service from 6PM this evening. Our D Doc centres in Coolock, Hartstown and Swords will be open. Appointments must be made prior to calling to our centres. Patients with urgent needs should first call 1850 22 44 77.

All D Doc centres will open tomorrow Saturday and we will also operate an emergency home visit service for palliative care and nursing home patients only. Because of the adverse weather conditions we will only have a limited number of appointments available.

If patients are feeling under the weather with any of the following symptoms,  Flu, colds, coughs, sore throats, ear aches, rash, temperature or tummy problems.) Click here for practical advice

If patients have an emergency they should call 999 or attend the local hospital emergency department.

Issued 02 March 1335hrs

Weather severely curtails D Doc out of hours service

The D Doc service has effectively been suspended from this evening, Thursday, March 1st until at least tomorrow, Friday evening. Callers can avail of nurse triage where they can get urgent advise and special arrangements are in place to assist palliative care cases and emergency nursing home queries.

The decision was made to close the D Doc appointment service on the advice of the  HSE taking into account the Red weather alert in place for Dublin and the Statement by National Emergency Coordination Group

Northdoc, working closely with the HSE will keep the situation under urgent review and services will be resumed as soon as possible.


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.

Northdoc First in Irish healthcare Awards 2017 for GP Innovation

At the Irish Healthcare Awards held in Dublin’s Mansion House Northdoc Medical Services won the award for Innovation. Tom Finn, CEO of Affidea presenting the award said the award was “for outstanding work in the form of improvement or innovations implemented by individuals in a general practice setting in either clinical or practice management level that improves the quality of patient care or helps free up GP time”

Dr Mel Bates, writing earlier this year in the Irish Medical times Said “The out-of-hours service is a very different environment to the familiar surroundings and supports of the daytime GP experience. Northdoc’s ‘Doctor’s handbook’ is a quick reference guide to support doctors working in the DDoc out-of-hours service.

We saw the lack of ‘easy to hand’ material that GPs are used to having in their day work and sought to fill this gap. The guide is a reference for GPs who come across unfamiliar patient presentations such as involuntary admissions, or vulnerable patient groups such as the homeless.

Throughout the handbook there are ‘Traffic Light Systems’ (e.g. sepsis in babies), age based heart and respiratory rates and ibuprofen/paracetamol dosing charts for young children. There are algorithms for acute bronchitis, acute gastroenteritis, colic, UTIs in infants and children, anaphylaxis and guidance on antibiotic dosage.

There is also a section on mental health, which gives guidance and samples of forms “that must be just right” for involuntary admissions. Samples of the MMSE (Mini-Mental State Examination), forms to be filled, and general tips on who to contact and where they can be contacted during out of hours is also included.

There is also useful guidance on vulnerable patient groups, including travellers, victims of assault and domestic violence.

“The patient makes their own assessment of the doctor in the first 20 seconds, hence the handbook includes advice on how to get this right every time.

Dr Mel Bates, Medical Director, Liam Quinn CEO Northdoc, Dr Brid Hollywood, Chair Northdoc, and Dr Des MacDonell, Director of Medical Governance Northdoc

Our own daytime experience may be mainly with children or the elderly. Working an out-of-hours shift, we may come across the homeless or victims of domestic violence or members of the travelling community for the first time. Dr Austin O’Carroll kindly wrote the section on the homeless, Dr Rosemary Gillan wrote on domestic violence, Dr Fiona Moynihan on Traveller’s Health and Dr Deirdre Lundy updated our emergency contraception section.

Profs John Murphy and Alf Nicholson, both of the Children’s University Hospital, Temple Street, kindly gave us permission to reproduce some of their paediatric algorithms in the children’s section of the handbook. These include a quick summary of the management of a number of common childhood ailments that might present out of hours. Child protection issues and how to deal with unaccompanied minors under 16 years of age presenting by themselves are also other important issues out of hours.

Every doctor who wants to work in DDoc for the first time has a face-to-face induction. This focuses particularly on how the system in DDoc works, whether the doctor starts with a car shift or treatment centre shift.

The handbook is colour coded and divided into four separate sections:

  • How it works
  • Children’s health
  • Clinical issues
  • Mental Health

The ‘SAFE’ in the title refers to Northdoc’s commitment to providing a Supported and professional service for both GPs and patients; an ‘Assessment’ system for clinical notes standards; a ‘Familiar’ environment across all the centres; and a commitment to continued ‘Excellence’ in the provision of GP care in North Dublin.

It is now planned to develop a smartphone app, making the advice even easier to access for the busy GP on-call.

The handbook was authored, edited, and designed in-house by Northdoc staff. Illustrations were done by Ciara Winkelmann. 

The Judging panel were Dr Dermot Power, Consultant Geriatrician – Mater hospital, Dara Gantley former editor of the Irish medical times, Dr Ellen O’Sullivan, consultant Anaesthetist – St James’s Hospital, Eoin McAtamney, President – The Pharmaceutical Managers’ Institute of Ireland. Dr Muiris Houston, Medical Journalist – The Irish times and Stephen McMahon, CEO – Irish patients Association.

by Liam Quinn





“If you have symptoms suggestive of measles you should stay at home” – HSE

The HSE have reported 7 cases of Measles in Dublin and Meath.

“If you have symptoms suggestive of measles you should stay at home”, not go to school or work and phone your GP or GP Out of Hours service and explain that you may have measles.

Anyone who develops measles symptoms should:

  • Stay at home and phone your GP or GP Urgent Out of Hours service
  • Tell the doctor or nurse that you think you might have measles
  • Stop visitors coming to the house to prevent spreading the infection

Prevent measles with the MMR vaccine:

  • All children should get MMR at 12 months of age and the second dose at 4-5 years of age.
  • If your child missed their scheduled MMR vaccine dose you should contact your GP to get the age-appropriate dose.
  • If you are an adult born since 1978 and have not received 2 doses of MMR you should contact your GP to get the MMR vaccine.

For full HSE press release click here.