International accounting firm called in to examine the costs of Laois out-of-hours GP service

Price Waterhouse Coopers were hired by the HSE to assess the 'financial challenges' in running the troubled GP out-of-hours services in Laois and other Midlands counties ahead of the breakdown in the partnership arrangement in late 2022.

However, the HSE also revealed that while the accounting and professional consultancy firm began their work with the agreement of doctors the process was never completed because of a dispute over the amount of money needed to maintain the service.

It's also emerged that the pressure from the public grew significantly in 2022 beyond 100,000 contacts over 12 months in Laois, Offaly, Longford and Westmeath.

The detail was published in reply to motions tabled at a recent meeting between HSE managament and councillors from the midlands and Dublin. Laois County Council cathaoirleach, Cllr Thomasina Connell, asked about the status of the service.

Other councillors asked the HSE to explain the circumstances surrounding the cessation of the company Midoc GP Company Limited by Guarantee to the HSE at Christmas. Midoc GP CLG is the company owned by midland GPs that allowed doctors to fulfill their contractual obligation in the medical card scheme to treat patients out of hours.

The HSE announced during Christmas week that GPs had informed them that the company had ceased trading.

The HSE provided further information to politicians at the Dublin Mid-Leinster Health Forum.

While it confirmed again that MIDOC GP CLG ceased trading as a private entity that coordinated the rotas/payments for the GPs who worked in the out-of-hours’ service, it said the out-of-hours service provision has not ceased in any of the Midlands counties.

It said the phone line is still operational and people who need care continue to be treated at centres in Portlaoise, Tullamore, Mullingar, and Longford. 

The answer explained how the breakdown of the partnership with the GP company came to pass.

"The HSE had been engaging with MIDOC GP CLG on their cash flow issue for a period of time and meetings since July 2022 had requested that MIDOC GP CLG partake in a collaborative financial examination by an independent company so that there could be a shared understanding of MIDOC GP CLG financial challenges which would inform the future financial and operational model.

"On 14 November 2022, MIDOC GP CLG confirmed they would partake in this independent financial review. This review commenced on 23 November 2022.

"The findings from the independent review were intended to support any changes to the operational and financial model for GP out-of-hours with HSE National Community Operations. The HSE had continued to provide ongoing financial support to MIDOC GP CLG while this examination by PwC (Price Waterhouse Coopers) was underway.

"Regrettably, despite the HSE providing written and verbal assurances that the HSE would continue to financially support the operation of MIDOC GP CLG to allow for the completion of the PwC examination and outcome thereof, MIDOC GP CLG wanted a guaranteed minimum amount of funding confirmed for January which due to the nature of cash flows the HSE could not provide a ‘guaranteed minimum’ amount.

"The HSE is disappointed that whilst providing funding MIDOC GP CLG to continue to operate MIDOC GP CLG that MIDOC GP CLG did not await the outcome of the independent financial review. The HSE is obliged in accordance with due diligence for all profit and not-for-profit organisations and MIDOC GP CLG will not be an exception to this," it said.

Midoc problems caused 'significant rise' in Portlaoise hospital A&E numbers

The HSE told councillors that MIDOC GP CLG advised their GP members on 23 December 2022 that the provision of out-of-hours services now reverts to the General Practitioners holding a GMS contract who are also members of MIDOC GP CLG.

The HSE outlined what it has put in place to maintain operations.

"In the short-term and to mitigate the risks, the HSE had to ensure, through a third party agency (that has already been providing medical support to MIDOC GP CLG that appropriate cover is in place for both the bridge shifts and the red-eye service from the 14 November 2022 based on normal and scheduled GPOOH practice and rosters. Most of the cost for 2022 was recouped from MIDOC GP CLG.

Watch: Crimecall appeal over burglary at Laois farm

A jeep and tools valued at over €9,500 were stolen in the burglary on Monday, January 9, 2020. The jeep was discovered in a badly damaged state in Tullamore, Co Offaly four days later.  

"During the Christmas period, the HSE engaged with the Irish Medical Organisation (IMO) and continued to provide communications to GPs. The HSE has ensured and will continue to ensure the provision of OOH services until such time as an alternative provider is in place. In addition the HSE met with an alternative provider however any decision around an alternative provider is the business of the GPs. The HSE is willing to support this process, if requested by the GPs," it said.

The HSE also provided press releases and social media posts which show how it kept the public informed about the situation at Christmas.

GPs have declined to comment on the situation.