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winter surge

IMO providing support to GPs to run additional clinics as winter virus infections surge

Chair of the IMO’s GP committee Dr Denis McCauley said there has been a “huge increase” in people presenting with respiratory illnesses.

THE IRISH MEDICAL Organisation (IMO) has agreed to provide temporary support to GPs to run additional clinics next month amidst rising demand for services due to a surge in winter virus infections.

Chair of the IMO’s GP committee Dr Denis McCauley said there has been a “huge increase” in people presenting with respiratory illnesses. 

It comes after the HSE said preparations are underway for the “highest pressure on the State’s health service that has ever been seen” due to the rise in infections.

The health service has expressed concern that it expects to see over 900 patients in hospital with flu in the first week in January, while a higher number of hospitalisations have occurred than had been anticipated in its “more pessimistic projections”.

A National Crisis Management Team has been established to oversee the response to the surge of winter virus infections.

Last week, the Chief Medical Officer Prof Breda Smyth urged the public to stay at home if they develop Covid-19 or flu-like symptoms in the run-up to Christmas Day, as Covid-19 cases began to mount.

In a statement to The Journal, McCauley said that GPs can volunteer to provide additional clinics for patients, but that they are under no obligation to do so.

“GPs and their teams are under enormous pressures at the moment and this has been the case for a number of weeks now so there is absolutely no obligation on GPs to undertake any additional or extended clinics,” he said.

“This will be a matter for each GP practice bearing in mind their capacity to do so and staff availability given the hours already being worked.”

He said out of hours GP services will continue to operate for patients who have urgent medical need.

“It is critically important at this time that people take measures to reduce the risk of infection by staying at home when they have symptoms and wearing masks on public transport or in crowded settings.

“GP surgeries and the out of hours services will continue to be under pressure over the coming weeks and will be focusing on those patients most in need of medical care.”

‘Huge increase’ in respiratory illnesses

Speaking on RTÉ’s Morning Ireland programme, McCauley said: “There’s a huge increase in respiratory illnesses generally and I think really, the number one thing is to ask people that if they have an infection just to stay at home, not to spread it and also to try and self manage this.”

He said that the respiratory syncsidial virus (RSV) seems to have peaked, and that people are mostly presenting with influenza and Covid-19. 

“Thankfully, the vaccination process has helped the morbidity associated with Covid. It seems to be influenza which is the primary thing though,” he added.

As of 8am this morning, there were 737 people in hospital with Covid-19, 35 of whom are in intensive care.

There are approximately 1,200 people currently hospitalised with respiratory conditions.

McCauley said that despite providing additional support to GPs, he is unsure how many will volunteer to run additional clinics due to existing capacity issues.

“It’s a temporary voluntary arrangement that if a general practitioner wants to extend his surgery into the evening to service the actual demand to assess the level of sickness. That’s what we have agreed,” he said.

“I think naturally, it isn’t that general practices is quiet that it can actually do this. We are very busy, we have our own capacity issues also. There’ll come a stage at around 4pm or 5pm in an afternoon where it’s got so, so busy that we can’t extend our surgeries now and actually see these patients.”

McCauley said hospitals are also experiencing increased demand for services. He said that Letterkenny University Hospital is under a “Code Black” emergency “96% of the time” because the hospital “haven’t got enough beds to service the need that is there”.

He also said that there may be a shortage of antibiotics following the recent Strep A outbreak.

“I think the fear associated with the Strep A has made patients and parents more inclined to attend early and as a result of that, the emphasis on the need for an antibiotic to treat Strep A means our negotiations with the patients about the needs of an antibiotic is much harder.

“There are more antibiotics being prescribed and therefore, there is a relative shortage from time-to-time.”

‘Crisis in general practice’

Speaking on RTÉ’s News at One programme this afternoon, medical director of the Irish College of General Practitioners (ICGP) Dr Diarmuid Quinlan said that while the group welcomes the extension to GP clinics, many GPs “are already working to capacity”.

“We have a crisis in general practice in our workforce. Our GP workforce is fully engaged working with the surge in Covid numbers, our population has exceeded 5 million for the first time since the famine,” Quinlan said.

“We also have the seasonal flu, respiratory syncytial virus, group A Strep and then we had the extension of the [General Medical Services scheme] to under sixes in 2015 and the proposed extension to 69-year-olds coming in 2023, all of which have added some very substantially to the GP workforce and workload crisis that we face.”

“In many instances, GPs are already working to the maximum that they can. In my own practice, that is very much the case. Most of my colleagues across Cork and Kerry who I’m familiar with, likewise, they’re working to absolute capacity.”

Quinlan said that SouthDoc, a company that provides out-of-hours GP services in Cork and Kerry, will be approaching a quarter of a million consultations for 2022, which is “substantially ahead of the last full year” of 2019.

He said eight out of nine people who attend SouthDoc are managed wholly in the community, while only one in nine who attend SouthDoc are referred to hospital. “There’s a huge amount of work managed in primary care without ever coming to hospitals,” he added.

Quinlan said the ICGP has called on the Government to set up a working group to look at the future of GP care and implement solutions to the “workload and workforce crisis in general practice” as an urgent requirement in January 2023. 

Speaking on the same programme, Chief Nursing Officer (CNO) Rachel Kenna urged those who are older or living with an illness to take particular care to look after their health over the Christmas period.

“There’s plenty we can do to stay well ourselves and we manage this extremely well most of the time, but just to be very conscious that during the holiday period, that social contact for older people may be reduced because normal services are on annual leave or holidays,” Kenna said.

“It’s really important to make sure that older people have social contact, and that we check in on vulnerable or older neighbours and relatives to make sure that they have things like medications, that they’re staying warm and that they are okay and well.”

She urged older or vulnerable people to wear a mask when meeting with people and to make sure that their vaccines are up to date. 

She also advised anyone who has symptoms of Covid-19 or a respiratory illness to stay in their homes. 

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