Budget pressures and challenges on GP Out of Hours service outlined at council committee

Between April and December last year, Western Urgent Care Out of Hour clinics had over 66,000 patient contacts, 70 percent of whom were given advice on the phone and 25 percent given face-to-face advice online.

During a presentation at Derry City and Strabane District Council’s Health and Community Committee meeting on Thursday, March 14, WUC’s Head of Business Support, Mr Pat Brolly, said there were five OOH bases across the West, including clinics in Strabane and Limavady.

OOH services mean healthcare provisions by GPs and other medical staff during evenings, weekends and bank holidays.

Between April and December last year, clinics had over 66,000 patient contacts, 70 percent of whom were given advice on the phone and 25 percent given face-to-face advice online.

Mr Brolly said that overall healthcare provision was a 'challenging environment, and OOH is not immune to that'.

He added that filling clinical rotas, particularly in Strabane, Limavady and Omagh, was particularly challenging due to GPs not having an obligation to work OOH, a shift in attitudes towards achieving life/work balance, and doctors’ preferences to work close to their own practices and homes.

“Also, like any part of the health service, there are budgetary challenges,” Mr Brolly said. “We provide additional financial support to OOH, and we’re always mindful to make sure this public money is used efficiently”.

SDLP councillor Jason Barr asked the panel about any potential resolutions to reinstate OOH services in Strabane, and questioned if five clinical bases were too many.

Sinn Féin councillor Paul Boggs initially proposed the presentation, as his Strabane constituents had been 'raising the issue [of lack of OOH service] constantly'.

He noted that the removal of evening slots for GPs in Strabane was supposed to be a temporary measure, and also asked if there were plans to reinstate them.

Councillor Boggs said: “When we got a deputation from Western Health, their plan was to keep people away from our bigger sites like Altnagelvin. However we don’t have the services at a local level, particularly in Strabane Town.

“It’s not there. People are frustrated because they feel they’re taking up an Emergency Department seat, where they may not need to be if someone had seen them locally to provide a prescription or more guidance.

“I welcome that you can have a conversation over the phone or face-to-face remotely, and that might be adequate for you, but there are still a number of people that don’t need to be in A&E but have nowhere else to go.

“There is also a significant and growing anxiety amongst support staff that the erosion of services will mean the erosion of jobs. We already have a situation where they aren’t being offered shift because they can’t drive to the place they’re offered the shift in.

“Is that good practice? Our and your focus is on rebuilding these services in Strabane, but we’re going to need those staff again when we get to that position.”

GP Medical Adviser, Dr. Ciara McLaughlin, said OOH services have seen a 'changing trend' towards phone call prescriptions and advice, but patients would only be directed to A&E if necessary.

“If you need to be seen on a given evening and your closest base doesn't have a doctor at it, you will still be offered a GP appointment,” she said. “You don’t have to go to A&E for GP-type issues no matter where you’re living.”

“You will still get a GP, or a nurse advisor, or a mental health practitioner dealing with your case no matter where you are. They work across the whole of the West and all patients have access.”

WUC’s Medical Manager, Enda McSorley, is a GP working out of Strabane.

He said there was a contractual obligation to have OOH services in all five bases, including Strabane, but this was 'really, really difficult with our current budget'.

“In fact, it’s impossible to run the service how we’d like on the budget we have,” Dr. McSorley said. "Seven or eight years ago we had a GP in Strabane, doing OOH on evenings from Monday to Friday, and covering the weekend.

“That’s why the service hasn’t been as good. It’s very haphazard as the GPs have been booking minimal shifts, so it wasn’t where it should have been.

“There needs to be value for money, so if you’re paying people they need to be working. We are going to need a dream budget in the next month to keep these bases going with doctors, support staff, and advanced nurse practitioners.

“That’s unlikely, and we’d need twice the budget to make that happen. We've had to reduce shifts, not just in Strabane, so this is really difficult and comes down to money.

“Investing in OOH actually saves money, because once someone is in A&E that’s a very expensive service. So, there would need to be decent investment for all of this to work.”

Dr. McSorley concluded: “I can’t say when Strabane will be up and running, because I don't know how much money we’ll get next month. We’re trying to make the best of what we have.”