Minister McGimpsey defends out-of-hours doctor cutbacks

Mr McGimpsey made the claim while telling MLAs that "we are employing a GP to be permanently based in Limavady to deal with two or three calls a night, at a cost of 1,000 per night".

In a lively adjournment debate at Stormont last week, the decision to change the way out-of-hours services in Limavady again came under the microscope.

The debate started shortly after 11pm, with East Londonderry DUP MLA George Robinson speaking first, saying he owes his own life to the service.

Mr Robinson said: "I have a petition with at least 5,000 signatures, which expresses the feelings of the public in the Limavady borough. The petition has cross-community and all-party support in the Limavady area.

"When I was first informed of the reconfiguration of GP services to cover the red-eye period, I knew that it would be a backward move for the people of Limavady. Nothing can justify a 40% manpower cut to a vital front line service. Regardless of the language used, in reality there will be two fewer doctors on duty and two fewer on call to cover the Western Health and Social Care Trust area, with Limavady greatest affected.

"The most worrying aspect was the complete lack of consultation, primarily with the public, who are most affected, but also with local elected representatives and staff who operate the service. Consultation took place only when I, as a member of Limavady Borough Council, requested a meeting. If the cut in the number of doctors was to prove so effective, why was the service not introduced in that form to begin with?

"The current service was the safest model for out-of-hours GP provision, and now it is to be cut. From 1 July, there will be one GP on duty from 12am, but what about the 11pm to 12am period? That GP will be based in Londonderry and will be expected to cover from Limavady to Strabane and the entire city of Londonderry. My understanding is that the planned triage nurses to assist the GP cannot do house calls and are not yet fully trained.

"The two other GPs on duty will be based in Enniskillen and Omagh; therefore, their ability to respond within the 20-minute target is seriously compromised. The same applies to the two on-call doctors. Their response time is compromised by the fact that they will be at home and by the time that they will need to get to the base. Too much of the argument for the cut relies on the on-call doctors and on the other duty GPs being available. It just will not be viable.

"At present, there is a GP on duty in Limavady and one on call at home. From 1 July, there is to be no doctor based in Limavady. A doctor driving from Strabane to Magilligan will have poorer response times to calls, possibly turning urgent calls into emergency ones. It is a total waste of the valuable time of highly trained doctors. That could put in danger patient outcomes and, possibly, lives.

"Many calls to the service are from terminally ill patients, sick children and nursing home patients. They are among the most vulnerable groups in our society and will be the first to suffer under the proposed changes. Other patients who will be affected adversely will be those who suffer strokes, heart attacks and many other serious and sudden onset illnesses. There is no plan B. There is no trial period. From 1 July, Limavady will lose yet another vital service. That is being done to save less than 05% of the Western Health and Social Care Trust's budget."

Mr Robinson urged the Minister "at least to introduce a compromise that the Western Health and Social Care Trust reduce the present proposal from five-doctor coverage to four".

And he said: "I say honestly and categorically that, if it had not been for the out-of-hours service in Limavady five years ago, I would not be standing here. I thank the medical staff who saved my life on that day at 6.30am. Had it not been for that service, about which I am so passionate, I would not be here today."

His views were echoed by Sinn Fein MLA Billy Leonard.

Mr Leonard said George Robinson was "absolutely right" to table the debate.

He continued: "It has been said quite dismissively that there has not been a complete policy change and, therefore, consultation was not required. That is grossly offensive to a public who have treasured that service. They have treasured the service because it has been a good service. I noted Mr Robinson's very serious personal anecdote. We were all struck by the number of people who turned up at the public meeting in Limavady and talked about the great service that they had been given. I anticipate that the Minister will respond by saying that the service is there and that it is being reconfigured, rather than cut out.

"There have been serious failings on the issue. I echo the appeals that have been made not only here but at the public meeting, as well as those that have been made through the petition and through letters in the press, asking for the decision to be reconsidered. I still stand by that."

Mr Leonard said he understood decisions have to be made about cuts at a local level, but added: "However, we are not talking about cuts at a micro level. We can still argue about the micromanagement of the out-of-hours service and at least bring the public's concerns to the House without having them dismissed so simplistically. At a public meeting, the commissioning group — not us — quoted figures of 600 a night and 900 for bank holidays, so surely there is room for movement with that... It is a genuine plea from the community."

In response to a number of speeches, Mr McGimpsey told MLAs: "Out-of-hours medical services will continue to be delivered from the Limavady out-of-hours centre, as they will from other western centres. Anyone who lives in the Limavady area who requires urgent medical services during the weekend or at night will continue to receive out-of-hours services. I repeat what I said in the House last week: that service is not being withdrawn. Patients will not experience any difference to the level and quality of service that they normally receive. I am disturbed that some Members are ignoring that fact.

"Over the past few months, I have answered a number of Assembly questions on the issue. Last week, I answered a question for oral answer in which I explained the situation, yet my explanations are simply ignored. Out-of-hours GP services are available for patients with an urgent medical condition who cannot wait until their GP practice is next open, and that remains the case. It is important that Members are clear that the out-of-hours service is not, and was never designed to be, an emergency service. George Robinson talked about strokes and heart attacks, and the normal procedure for people in such a situation is to ring 999 for the Ambulance Service. The Ambulance Service in Northern Ireland, including the Limavady area, is very good...Anyone who contacts the out-of-hours service for the support provided by a general practitioner will have their calls triaged within 20 minutes by a trained nurse. Some people may require a consultation with the doctor, some may be given advice for self-care and others may be referred to the Ambulance Service."

Mr McGimpsey said the out-of-hours services are commissioned from five providers in Northern Ireland at an annual cost of 21 million.

He went on: "There are around five calls a night from Limavady to Western Urgent Care after midnight, and possibly three, but usually two, of those calls require a GP consultation. Therefore, we are employing a GP to be permanently based in Limavady to deal with two or three calls a night, at a cost of 1,000 per night. There are better ways to do that. Those two or three patients will continue to receive a consultation either at home or in the Limavady centre, but there will not necessarily be a GP sitting there dealing with the two calls — the patients may be dealt with by another GP. There was talk of a public consultation, but the service is not changing. The service will remain... The cost of delivering the service is 1,000 a night, but we plan to save 600,000 as a result of the proposed changes in the Western Trust.

"For the benefit of George Robinson and others, let me say that 600,000 would pay for around 50 cardiac operations a year. Would they prefer it if I paid for a GP to sit in the Limavady out-of-hours centre to deal with two or three patient consultations either in the centre or in their own home, or would they rather that we saved 600,000, which is the equivalent of around 50 cardiac procedures, and still looked after those two to three patients, but with a GP coming from elsewhere rather than being based in Limavady? It seems to me that that is a simple question.

"Billy Leonard might say that when it comes to votes for cuts, I am not talking about the micro level, but cuts are cuts. You and your party voted for cuts, Mr Leonard, not once, not twice, but three times, so do not come here and complain about changes. There will be changes, but we will not cut the service. It will continue, but it will be done in a more effective and efficient way."

He also said: "I understand that one GP earns 5,000 a month as part of that service. We can save that money and still maintain the service. We are not changing; we are not taking the service away. That is not the proposal, and it never was."

The minister said out-of-hours services will continue to be provided from Limavady out-of-hours centre between 6.30pm and 8.30am Monday to Friday, at weekends and on public holidays.

He also said: "Changes that have been proposed relate to services between midnight and 8.30am only. No GP will be based on site in the Limavady centre between those hours. However, patients who contact the centre out of hours will have their calls triaged by a nurse. GP consultations will still be provided where appropriate, either through an out-of hours GP attending the Limavady centre or through a home visit. That service can be provided without having a GP sitting in the Limavady centre, particularly when there are just two or three patients each night...

"Western Urgent Care will have additional GPs on call. They can be used to support Limavady out-of-hours service should there be an unexpected increase in demand. If the two or three patients who contact Western Urgent Care out of hours between midnight and 8.30am require a GP consultation, they will get it. If they require consultation at the centre, they will get it. If they require it at home, they will get it. That service is provided not only in Limavady but in the Western Trust area. The Department endeavours to provide that

throughout Northern Ireland."