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.”

Now in its 10^th 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. 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.

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.
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.”