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On-call GP service 'majorly concerned' over plans to require referrals for patients to Navan

Out-of-hours doctors in Navan say the hours they operate are due to be curtailed in August.

GPS WORKING WITH the North East Doctor On Call service (NEDOC) have told Our Lady’s Hospital Navan that it will not accept the care of patients who would normally have been assessed and managed in a hospital setting. 

Correspondence sent to all politicians in the region from NEDOC, seen by The Journal, raises serious concerns about the need for patients to have a GP referral before accessing the HSE’s planned Medical Assessment Unit (MAU) at the hospital.

The HSE said earlier this week that the facility would be given that status and would no longer be a full Emergency Department – however their position is at odds with the official view of the government. Health Minister Stephen Donnelly said on Tuesday that no decision had been made.

“It is of major concern that potential stroke or cardiac patients will not have direct access to the MAU and will be required to have a GP referral letter to the MAU, risking unnecessary delays in their treatment,” the letter states.

It goes on to state that it has advised the hospital that its GPs “will not be in a position to undertake the management of acute hospital requiring presentations such as stroke, acute chest pain, collapse etc and will continue to triage these patients directly to their nearest hospital”.

NEDOC provides an urgent out of hours GP service to patients in Louth, Meath, Cavan and Monaghan.  

Emergency Department closure

Controversy has rumbled over the future of Our Lady’s Hospital after the HSE announced on Monday the final phase for the Co Meath hospital becoming a “model 2” facility.

The HSE insisted that the new MAU will still be able to see around 80% of the current number of patients who present to ED every day.

However, it has been confirmed that the planned MAU will be GP referral 24 hours a day, 7 days a week, while a proposed injury unit will be walk-in. 

Politicians have been raising concerns about what effect the “downgrading” will have on patient access to emergency care in the area, and about what knock-on effects it will have on capacity at Our Lady of Lourdes in Drogheda.

On Tuesday, in the wake of Donnelly’s statement saying no decision had been made, The Journal asked Tánaiste Leo Varadkar if the Department of Health and HSE are at odds with one another over the hospital.

He confirmed that no Government decision on the ED closure had been agreed with the HSE. The Tánaiste said there “are a lot of questions to be asked” about whether it is “wise” to close the ED in Navan. 

GP referral needed to access services

Given that the HSE’s planned MAU will require 24 hours GP referral for patients to access the service, many of the referrals will fall to the NEDOC. 

In the correspondence, NEDOC Operations Manager Arlene Fitzsimons states it “cannot accept any attempt to involve NEDOC in un-negotiated prehospital care pathways or assessments”.

With referrals needed to the proposed new unit, she said NEDOC would be concerned at the “impact this will have on general practice in the region” as it “will create further pressures on an already overloaded daytime and out-of-hours GPs”.

NEDOC is currently an appointment-only service, that operates out of a clinic in Navan.

“Practices already find their appointments overbooked each day with little scope for additional same-day appointments to manage referrals to the MAU,” said the operational manager.

The letter added that NEDOC service is in the process of reconfiguring overnight services “due to significant and ongoing underfunding and manpower resources”.

Face-to-face appointments throughout the north-east region are due to be curtailed, and therefore will seriously undermine the plan for referrals to be needed to access the MAU in Navan Hospital.

Instead of operating from 6pm to 8am daily, the service is to be curtailed on 4 August, with the service only providing urgent GP out-of-hours care to patients on a face-to-face basis until 10.30pm weekday evenings and 10pm at weekends.

Thereafter, patients will have access to GP telephone advice only.

The changes are as a result of acute doctor shortages and underfunding of the service by the HSE, said the operations manager, who added that the HSE had been notified of the issues facing NEDOC for overnight sessions for some years. 

‘Stop-gap’ for GPs day service

The letter states that when NEDOC was established it was meant to be an urgent out-of- hours GP service.

However, with time the service has become “a convenient alternative to day surgery while also being the stop-gap for other health services that choose not to arrange out-of- hours cover but allow their patients to default to NEDOC”.

“While there is clearly a demand for an out of hours service for primary care it cannot be provided by GPs already overburdened in their daytime practices,” said Fitzsimons. 

She said NEDOC has attempted to meet the HSE to discuss how such a service could be provided with GP support but to date their requests to meet HSE officials have been refused.

The operations manager adds that the NEDOC service will also be unwilling to accept presentations outside the safe scope of practice for a GP out-of-hours service.

“Our doctors cannot be expected to accept the risk created by delays in hospital or pre-hospital emergency care to patients with non-GP appropriate presentations,” she states.

‘No referral means no access’

Meath TD Sinn Féin’s Darren O’Rourke said the 24/7 MAU proposals will not work as GPs have now confirmed there is an acute doctor shortage. 

With no GP means there will be no referrals for access to the MAU. He said this means up to 20,000 patients will need to be treated at the Lady of Lourdes Hospital ED in Drogheda, which is already overcrowded. 

A number of public meetings in Navan are due to be held shortly, including on Monday, where Sinn Féin leader Mary Lou McDonald will be in attendance.

The party will bring forward a motion in the Dáil next week on the closure of the emergency department at Navan Hospital.

‘Very concerned’

Speaking about the latest development in the controversy, Meath Fine Gael TD and Minister of State for Business, Employment and Retail Damien English has said he is “very concerned” about the concerns raised by NEDOC.

English said he is also “really, really annoyed” with the HSE, stating that politicians in the area had been reassured that the new plans for Navan Hospital were done in full consultation with GPs in the area, which he said is clearly not the case.

In a statement, English said he had spoken with Health Minister Stephen Donnelly several times in recent days and that he had been assured no decision regarding the HSE’s proposal has been agreed by this Government.

“It is simply not good enough that the HSE tried once again to implement proposals without a consensus from the medical experts in Meath who operate on the ground for the betterment of their patients. What is now needed is a full and open debate and proper analysis, including with all the GPs from the county, as to what is best for the future health needs of our growing population of Co. Meath. I am not convinced by these plans,” he said.

Earlier this week, Gerry McEntee, clinical director of Our Lady’s Hospital, Navan, stressed the risk for critically ill people who attend the Navan hospital.

“I don’t know if the public really realise, but this [is a] cohort of critically ill patients who by virtue of the fact of coming into Our Lady’s Hospital, Navan, are not provided with the best opportunity of survival,” he told RTÉ’s News At One radio programme.

When asked whether it was safe for the emergency department to continue as it is, Gerry McEntee said “it is absolutely not safe”.

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