Derry mother says shortage of out-of-hours doctors is putting children at risk

A concerned mother has highlighted a shortage of out-of-hours doctors in Derry which she says is impacting on the quality of care locally and leading to increased numbers in A&E departments.

Derry woman Maria Cassidy explained that her 5-year-old boy needed to be assessed in the early hours of the morning as he has asthma and was experiencing problems breathing.

Ms Cassidy contacted Western Urgent Care (WUC) when she was informed that the child needed steroids but there were no out-of-hours doctors in Altnagelvin or the Derry Area. 

“I was advised I’d have to wait for a GP or go and wait in A&E,” Ms Cassidy explained.

“It’s putting already pressurised A&E staff under immense strain.

“People who need a doctor are having to weigh up the risk of taking their child to A&E - having them wait hours, being witness to drug and alcohol abuse, aggression, scenes of self-harm, antisocial behaviour and Covid or waiting hours before their GPs open.”

Ms Cassidy also learned that there was no out-of-hours doctor available on different day last week from a parent who had a similar experience. 

As a result, an ambulance had to be called on that occasion.

The GP out-of-hours service in Derry is normally provided at the Altnagelvin Hospital site.

Due to the Covid-19 pandemic the service has operated from Great James Street Health Centre. There are plans to return to the Altnagelvin site in the coming weeks.

The Western Trust Facebook page frequently posts about numbers waiting in Altnagelvin A&E but Ms Cassidy said that doesn’t reflect the fact that it's ‘probably due to the lack of out-of-hours doctors’.

A presentation was also recently delivered to Derry City & Strabane District Council about the out-of-hours service during which councillors were told there are difficulties with getting doctors to work shifts.

A spokesperson for the Health and Social Care Board (HSBC) accepted that the service provided by WUC faces similar ‘challenges’ to the other out-of-hours providers across Northern Ireland as a result of ‘demand and difficulties’ in filling GP shifts.

Whilst the service has faced on-going difficulties in securing GPs to fill shifts, the spokesperson said, it has continued to skill-mix its workforce to ensure that patients’ urgent clinical needs can be met by the most appropriate healthcare professional.

She explained: “Where fewer doctors are available than scheduled, WUC will plan the clinical workforce to best meet the needs of patients. 

“The majority of patients who contact the Out of Hours service do not need to be seen face-to-face by a GP, nor clinically triaged by a GP.

“Many patients can be safely and effectively clinically triaged by either a Nurse Advisor, Prescribing Pharmacist, Paramedic Practitioner or Nurse Practitioner.

“Patients can receive clinical advice from a Nurse, have a prescription confirmed by a Pharmacist or be seen in their home by a Paramedic Practitioner. 

“This means that the GPs and Nurse Practitioners will be available to see clinically urgent patients face-to-face, should it be necessary.”

SERVICE DEVELOPMENT

At times, the HSCB spokesperson said, even if there is a GP in their local base patients will be instructed to attend their local Emergency Department due to the severity of their condition.

WUC has introduced a number of processes to deliver urgent care in alternative ways to patients, such as the use of video consultations and arranging for prescriptions to be sent to the patient’s local pharmacy.

However, according to the HSCB, patients who have an ‘urgent clinical need’ will still be prioritised and offered a face-to-face appointment. 

The spokesperson continued: “Where an Out of Hours base is not fully staffed and several patients need to be seen in that area, Western Urgent Care arrange for a clinician to travel from another base to attend and see these patients. 

“The GP also undertakes any home visits needed for patients in the area before returning to their original base.

“Alternatively, a patient can be offered an appointment at an alternative base or with the GP who is working the next shift in their local base.

“Western Urgent Care continues to work with GPs and the Health and Social Care Board to identify opportunities to develop the Out of Hours Service to meet the needs of patients.”