GPs have HSE 'over a barrel' on out-of-hours care in Laois and Midlands claims TD

The threat to out-of-hours GP care in the Laois and other counties can be traced to being dependent on doctors and private companies whom he said can 'pull the plug' if they don't get enough income to deliver the service.

Laois Offaly TD Brian Stanley put it bluntly to people at the top of the HSE when they met with him and other TDs in the Dáil on spending on the health service. The spending included up to €8 million on GP out-of-hours care in the Midlands and €90 million spent nationally.

"The simple fact is that the GPs and whoever the private providers are have the HSE over a barrel," he said at the Dáil Public Accounts Committee.

He put it to the HSE's Chief Executive Stephen Mulvany: "Is that not the simple truth of it?"

Mr Mulvaney replied: "I do not think we would characterise it like that. In fairness to our GP colleagues, they put a lot of effort in".

The Laois Offaly TD and Chairman of the committee acknowledged that individual GPs are "doing fantastic work" but he cited the example of Midoc, a GP-run company, pulled out over what he claimed was money. He did accept that some GPs in the Midlands "may not have been paid for the services they provided at different times" but he insisted money is the issue.
 

"However, what I am saying to Mr. Mulvany is that when depending on agencies and private companies to do the administration and all that type of thing, they can pull the plug if they do not get the cash, or sufficient cash. Is that not correct?"

Mr Mulvany disagreed.

"Typically, we deal with a group of GPs, either as part of a company or a cooperative. In some cases, as in this case, that group of GPs will have 40 subcontracted part of the work to another company. Usually, there are only two parties, namely, the HSE and the GP group, and in some cases, there are three, at most," he said.

However, Dep Stanley, countered that the company which provided the service for most of the midlands, Midoc GP CLG, has now ceased trading.

Roaring and shouting in Laois village

Damian McCallion, HSE Chief Operations Officer, also confirmed that spending on GP out-of-hours services is in the range of between €90 million to €100 million per year nationally and €7.8 million for the midlands services.

Dep  Stanley said that he was notified on Christmas Eve that a company limited by guarantee would be "pulling the plug" on its out-of-hours services in Laois-Offaly and Longford-Westmeath.

He said engagements might not have been what they needed to be, and then he claimed "the plug was pulled".

"The problem is that we are left with a collapse in essential services at the same time that emergency departments and hospitals are overloaded," he said.

The HSE agreed that the system of out-of-hours care is convoluted but insisted that management in the Midlands ensured the service is continuing despite the fact that the GP company pulled out.

"I absolutely agree with the Chairman, but the HSE is delivering approximately 80% of the service. In fairness, the chief officer in the area should be commended - the Chairman has commended that individual - for making sure there was no loss in continuity of service," he said.

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Mr Mulvany said there are five cells in the midlands, four of which were covered by Midoc GP CLG.  He said the HSE provides and fully staffs the call-taking service in Ardee. It provides and staffs fully the triage nurse service based in the Scott Building in Tullamore. A further 50 staff, including ancillary support staff and drivers, are also employed. He said the GPs provide or did provide, the input to that service.