Use of out-of-hours medical services as “surrogate GPs” impacts level of care


The shortage of GPs in Ireland is pushing people to use out-of-hours emergency medical services as a ‘surrogate GP’ service, according to a Kildare-based doctor.

Dr Brendan O’Shea, Adjunct Adjunct Professor in the Department of Public Health (Primary Care) at Trinity College Dublin, believes this practice is not suitable in the long term as it leads to a lack of continuity of care.

“General practitioner co-operatives were created to provide episodic, short-term care for medical problems too urgent for a patient to wait for their own doctor to see.

“That’s what they’re designed for – they’re not resourced or designed to replace what’s done in general practice,” says Dr. O’Shea.

A member of the KDOC GP cooperative which operates in Nass and Celbridge, he estimates that between 5 and 15% of people who access these services use them instead of a regular GP, impacting their level of long-term care.

“The risk of significant interaction of prescription errors is much higher if they are seen by doctors who do not have the opportunity to know them.

“We know on an actuarial basis, for example, that a small portion of counseling around depression will go wrong and that increases the likelihood of things like suicide.”

Dr O’Shea points out that there are a number of medical conditions for which continuity of care is particularly important, including hypertension, diabetes, chronic pain and other mental health conditions such as anxiety. .

“Very insufficient”

Compared to other countries, the capacity of Irish general practice is “woefully insufficient”, which has “huge knock-on effects”.

“There are not enough GPs,” says Dr O’Shea, with ICGP figures showing Ireland has 30% fewer GPs per capita than the UK.

“If you don’t have that capacity in GP, ​​care overflows into the wrong places, including GP co-ops and emergency services.

“Our colleagues in the emergency department are saying they need more beds, we need bigger hospitals, we need bigger emergency departments, but if you have a constant flow of people going to the wards emergency and should be cared for in general practice, you actually need more general practitioners. .”

Ultimately, to address the current shortage of GPs, Ireland needs to train, recruit and retain more GPs, which the ICGP is working on by increasing the number of trainees under the National Scheme but, adds Dr. O’Shea, we also need to ensure funding for primary care is used effectively.

“We actually put quite a large amount of funding into the public health system, but we really have to ask ourselves how the money is being spent.


General medicine faced with an “unprecedented” workforce…

“In Ireland we estimate that only 4% of the health budget is spent on general medicine/primary care – in most of Europe and in the NHS (UK) it is between 8 and 11%,” he says.

In the short term, for people who cannot access GP services because GPs in their area have reached capacity and are no longer taking new patients, says Dr O’Shea, although not not always ideal, “no one will be turned away” from emergency medical services after hours.

With more GPs being trained, which should lead to more GPs in the community, he advises those looking for a GP to stay up to date on social media and in community groups so they can register with any new doctors who come to their area.

While not an immediate solution, Dr. O’Shea also stresses the importance of raising the issue with local elected officials. “Ask them what they’re doing about it,” he says. “The more of these letters that hit home, the more likely it is that politicians will start asking more serious and targeted questions of the Department of Health and the HSE.”


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