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THE IRISH MEDICAL Organisation (IMO) has agreed to provide temporary support to GPs to run additional clinics next month amidst rising demand for services due to a surge in winter virus infections.
Chair of the IMO’s GP committee Dr Denis McCauley said there has been a “huge increase” in people presenting with respiratory illnesses.
It comes after the HSE said preparations are underway for the “highest pressure on the State’s health service that has ever been seen” due to the rise in infections.
The health service has expressed concern that it expects to see over 900 patients in hospital with flu in the first week in January, while a higher number of hospitalisations have occurred than had been anticipated in its “more pessimistic projections”.
A National Crisis Management Team has been established to oversee the response to the surge of winter virus infections.
Last week, the Chief Medical Officer Prof Breda Smyth urged the public to stay at home if they develop Covid-19 or flu-like symptoms in the run-up to Christmas Day, as Covid-19 cases began to mount.
In a statement to The Journal, McCauley said that GPs can volunteer to provide additional clinics for patients, but that they are under no obligation to do so.
“GPs and their teams are under enormous pressures at the moment and this has been the case for a number of weeks now so there is absolutely no obligation on GPs to undertake any additional or extended clinics,” he said.
“This will be a matter for each GP practice bearing in mind their capacity to do so and staff availability given the hours already being worked.”
He said out of hours GP services will continue to operate for patients who have urgent medical need.
“It is critically important at this time that people take measures to reduce the risk of infection by staying at home when they have symptoms and wearing masks on public transport or in crowded settings.
“GP surgeries and the out of hours services will continue to be under pressure over the coming weeks and will be focusing on those patients most in need of medical care.”
Speaking on RTÉ’s Morning Ireland programme, McCauley said: “There’s a huge increase in respiratory illnesses generally and I think really, the number one thing is to ask people that if they have an infection just to stay at home, not to spread it and also to try and self manage this.”
He said that the respiratory syncsidial virus (RSV) seems to have peaked, and that people are mostly presenting with influenza and Covid-19.
“Thankfully, the vaccination process has helped the morbidity associated with Covid. It seems to be influenza which is the primary thing though,” he added.
As of 8am this morning, there were 737 people in hospital with Covid-19, 35 of whom are in intensive care.
There are approximately 1,200 people currently hospitalised with respiratory conditions.
McCauley said that despite providing additional support to GPs, he is unsure how many will volunteer to run additional clinics due to existing capacity issues.
“It’s a temporary voluntary arrangement that if a general practitioner wants to extend his surgery into the evening to service the actual demand to assess the level of sickness. That’s what we have agreed,” he said.
“I think naturally, it isn’t that general practices is quiet that it can actually do this. We are very busy, we have our own capacity issues also. There’ll come a stage at around 4pm or 5pm in an afternoon where it’s got so, so busy that we can’t extend our surgeries now and actually see these patients.”
McCauley said hospitals are also experiencing increased demand for services. He said that Letterkenny University Hospital is under a “Code Black” emergency “96% of the time” because the hospital “haven’t got enough beds to service the need that is there”.
He also said that there may be a shortage of antibiotics following the recent Strep A outbreak.
“I think the fear associated with the Strep A has made patients and parents more inclined to attend early and as a result of that, the emphasis on the need for an antibiotic to treat Strep A means our negotiations with the patients about the needs of an antibiotic is much harder.
“There are more antibiotics being prescribed and therefore, there is a relative shortage from time-to-time.”
Speaking on RTÉ’s News at One programme this afternoon, medical director of the Irish College of General Practitioners (ICGP) Dr Diarmuid Quinlan said that while the group welcomes the extension to GP clinics, many GPs “are already working to capacity”.
“We have a crisis in general practice in our workforce. Our GP workforce is fully engaged working with the surge in Covid numbers, our population has exceeded 5 million for the first time since the famine,” Quinlan said.
“We also have the seasonal flu, respiratory syncytial virus, group A Strep and then we had the extension of the [General Medical Services scheme] to under sixes in 2015 and the proposed extension to 69-year-olds coming in 2023, all of which have added some very substantially to the GP workforce and workload crisis that we face.”
“In many instances, GPs are already working to the maximum that they can. In my own practice, that is very much the case. Most of my colleagues across Cork and Kerry who I’m familiar with, likewise, they’re working to absolute capacity.”
Quinlan said that SouthDoc, a company that provides out-of-hours GP services in Cork and Kerry, will be approaching a quarter of a million consultations for 2022, which is “substantially ahead of the last full year” of 2019.
He said eight out of nine people who attend SouthDoc are managed wholly in the community, while only one in nine who attend SouthDoc are referred to hospital. “There’s a huge amount of work managed in primary care without ever coming to hospitals,” he added.
Quinlan said the ICGP has called on the Government to set up a working group to look at the future of GP care and implement solutions to the “workload and workforce crisis in general practice” as an urgent requirement in January 2023.
Speaking on the same programme, Chief Nursing Officer (CNO) Rachel Kenna urged those who are older or living with an illness to take particular care to look after their health over the Christmas period.
“There’s plenty we can do to stay well ourselves and we manage this extremely well most of the time, but just to be very conscious that during the holiday period, that social contact for older people may be reduced because normal services are on annual leave or holidays,” Kenna said.
“It’s really important to make sure that older people have social contact, and that we check in on vulnerable or older neighbours and relatives to make sure that they have things like medications, that they’re staying warm and that they are okay and well.”
She urged older or vulnerable people to wear a mask when meeting with people and to make sure that their vaccines are up to date.
She also advised anyone who has symptoms of Covid-19 or a respiratory illness to stay in their homes.
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There’s lots of people with respiratory illnesses every winter. Stop acting like this is out of the ordinary.
@Loretta Loretta: And leave the GP’S alone. They are working flat out as it is.
@Dave Barrett: but are they really? My GP opens from 9.30-12 and from 2-4.30 I wouldn’t consider that being overly worked
@Blackie Connors: those are the hours they see patients. They also have hours of paperwork and medical legal reports to do.
@Loretta Loretta: this is out of the ordinary though.
Look what happened in Australia their last Winter?
And look at emergency rooms all over Europe now.
The combination of Flu (low enough vaccine uptake) after two winters where travel-restrictions prevented it spreading, RSV, which has also come back with a bang and ongoing Covid issues (disproportionally affecting the unvaxxed) and you get the already struggling health services in dire straits.
There’s no need for panic though and we can all do our bit by staying home if we’re unwell etc.
Simple things.
@Loretta Loretta: Usually people can get an appointment with their GP – and others around them are healthy and can drop in supplies and help them out with childminding, dog-walking, feeding pets… All of that goes out the window when every other person you know is down with a bad dose as well. You’d do better to ask your neighbours and friends what you can do to help them get through this outbreak. I’m sure they’d do the same for you. Besides, everything you gloss over is five times harder for the thousands of people who are homeless right now, even if they have somewhere to stay, it’s obviously going to be overcrowded.
@Blackie Connors: Have you any idea how many patients they see during those hours.
@Loretta Loretta: Just the facts:
RSV infections two weeks ago (latest figures) were around 2.5 times higher than the previous record going back 10 years (502 v 200 infections in the 2015/16 season) but are now falling (RSV infections were 3.4 times higher than the previous record two weeks ago, 678 v’s 200 infections in the 2015/16 season):
Week 48:
“RSV notifications: 678 RSV cases including 239 hospitalised cases were notified during week 48 2022. During week 48 2022, 49% of notified RSV cases were in the 0-4 year age group and 25% were in those aged ≥65 years.”
And Week 50:
“502 RSV cases including 187 hospitalised cases were notified during week 50 2022. Age specific rates were highest in those aged less than one year.”
The previous weekly RSV infections peaks were 160 RSV cases in 2019 and 150 RSV infections in 2018, these were described as typical levels. And the highest peak on record (going back 10 years) was during the 2015/16 season, that peaked around 200 infections a week. No info on numbers hospitalised though.
Flu levels are continuing to increase, they were 66.5 per 100,000 2 weeks ago, it was 38.6/100,000 a week before, thus flu infections almost doubled in a week.
There were no Flu deaths in week 50, there were 11 flu deaths over the previous 4 weeks.
@Blackie Connors: unfortunately for them I doubt they don’t work outside those times. GPs are usually set to 15 mins per appointment so often run over time, hence the reason for limited hours for taking appointments. Usually they wouldn’t finish seeing patients till an hour after the stated time and that’s before you take into account paper work and all sorts of beaurocratic nonsense because of the fact that Irish people love litigation
@Loretta Loretta: but this is an out of the ordinary amount of respiratory illnesses. Ireland unfortunately doesn’t have capacity to treat it and so they are writing this article to inform people and ask them to be vigilant and aware of it. I wonder did you read the article itself before commenting
@Dave Barrett: Bad advice. Contact your GP before going to ER.
@Dave Barrett: these days there is no such thing as a walk in clinic any more. If you need a GP these days, you either wait for nearly a week or go to A/E…..so no, they are not flat out as you call it.
Our GPs seriously opened all day everyday. They also ran a vaccine clinic where it was literally all hands on deck. They looked physically exhausted by September last year and they’re still working and still had lots of time for problems not covid related, like they weren’t saying yeah yeah and rushing you out the door. For them, I would say, they couldn’t possibly have done any more.
I find it funny how after bombarding us with hourly COVID figures for two years the media and government are now maintaining radio silence. While I’m not overly concerned about COVID I do think the lack of data being released shows how a small number of people can influence what information we receive.
@Sean Higgins: COVID-19 figures are genuinely low. We’re dealing with a relatively milder virus and we now have high levels of immunity from vaccination and past repeat infection (while immunity might not prevent re-infections, it keeps symptoms mild or asymptomatic). There really isn’t anything to report on.
@Sean Higgins: the numbers are still updated daily. You’d need to have been living under a rock for the past two years to not know where to find them.
@Sean Higgins: The weekly Covid deaths are still happening, though.
have your say