Huge rise in holiday demand overwhelms out-of-hours GP services

Out-of-hours GP services were overwhelmed by Christmas demand, with patient increases reaching more than 50 per cent in some cases compared with last year.

The surge has been explained in part by the introduction of the free under-six GP service and the knock-on effect it has been having on appointment availability in an out-of-hours service intended for urgent care.

Rocketing demand for GPs has come alongside a rise in the number of patients left on trolleys in Irish hospitals, and both are partly related to rising influenza and winter-related illness levels, health experts say.

Dr Gary Stack, medical director of SouthDoc, which covers all of counties Kerry and Cork, said its doctors saw an overall rise in demand of 46 per cent over the holiday period, with 12,615 patients this winter, compared with 8,662 last year. Those numbers relate to two busy periods from Christmas Eve to December 27th and over the new year weekend.

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“The flu certainly accounted for a lot of that, but the under-sixes is the biggest issue,” he said. “Patients are now experiencing difficulties in getting to see their own GPs by day.”

Manpower problem

Mr Stack said manpower was also a significant problem in Ireland. In the Kerry/Cork area, there would shortly be 18 GP positions vacant, but cuts to contracts in recent years had made it more difficult to find people to take up vacancies.

There are about nine out-of-hours GP “co-ops” in Ireland and, said Mr Stack, all were under pressure over the Christmas break to meet intensive demand. This issue featured prominently on GP forums and Twitter.

"Every year we are just seeing the numbers [of out-of-hours contacts] rising and rising. The big issue is that it's becoming unsustainable," said Dr Illona Duffy, medical director of Nedoc, which covers the northeast.

From Christmas Eve until Tuesday, the region's GPs dealt with 5,800 out-of-hours patients, a rise of 15 per cent on 2015/2016, which itself saw an increase of 20 per cent on the previous year. By 4pm on one afternoon, all four centres in Cavan, Castleblayney, Navan and Drogheda had exhausted their appointment capacity until 1am.

“The under-sixes [provision] has had a massive effect, as we knew it would all along. Some of it has become routine use as opposed to urgent use,” said Ms Duffy. “There just isn’t the GP manpower on the ground to deal with it.”

Minister for Health Simon Harris acknowledged the issue yesterday, saying there had been an increase of 50 per cent in those using such services over Christmas and more in the New Year period.

“We have seen sustained increases in pretty much every out-of-hours GP service right across the country – 30 per cent, 40 per cent, 50 per cent increases in attendances on last year,” he said.

The resourcing of general practice needed to be addressed in the context of a new GP contract, the Minister said, with talks due to begin this month.

Responses to trolley numbers

Mr Harris also met Health Service Executive management to discuss a number of potential responses to the rising number of hospital patients on trolleys, and he plans to do so again on Thursday.

Possible measures include extending the availability of diagnostics services in hospitals; reviewing the length of stay for patients; assessing alternative care in nursing homes; and encouraging the uptake of flu vaccination.

The Health Protection Surveillance Centre said the rate of influenza had doubled in the past week and was expected to increase further. Older people in particular are at a greater risk of contracting the predominant AH3 strain.

So far this season, 96 people have been hospitalised with the illness.

Irish Nurses and Midwives Organisation general secretary Liam Doran said the situation had been complicated by an ageing population, inadequate community facilities and, crucially, a lack of acute bed capacity, particularly outside the Dublin region.

He stressed that this lack of capacity was not because of delayed discharges – the failure to discharge patients in a timely fashion after the acute part of their care has ended – as hospitals had already made progress on tackling this issue.

“It’s not that famous term ‘bed-blockers’. I hope I am wrong, but one would be very concerned about the coming days,” he said.