National Review of GP Out of Hours Service - Health Service ...

3. Background
The Form of Agreement with Registered Medical Practitioners for Provision of
Services under Section 58 of the Health Act 1970 (Section 10) places an obligation
on each contracted medical practitioner to “make suitable arrangements” to enable
contact to be made with him/her or their locum/deputy outside normal hours for
urgent cases. The arrangements to provide such a service varied nationally where
rotas were established ranging from 1:1 to 1:10 where GPs made arrangements
with
neighbouring practices. Commercial deputising agencies who provide
practice cover outside contracted hours are mostly availed of by GPs in Dublin.
Prior to May 1997, out of hours work applied only during the period of 10pm to
8am. In May 1997 new arrangements were agreed for claiming out of hours
general practitioner rates, where an out of hours’ fee was paid in respect of non‐ routine consultations necessarily undertaken during the following
hours:
Monday to Friday Outside the hours of 9am to 6pm
Saturdays Outside the hours of 9am to 1pm
Sundays and Bank Holidays All hours
(Excluding consultations made during normal contracted
surgery hours which were outside the above
hours and excluding consultations made as part of an overflow occurring in normal surgery hours)
In
Feb ruary 1998 the above hours for claim ing out of hours work were revised to:
Monday to Friday Outside the
hours of 9am to 5pm
Saturdays, Sundays and Bank Holidays All hours
Reflecting the new out of hours’ arrangements, there was a major increase in the
number and cost of out of hours’ claims over the period. Between 1995 and 1999
the
number of claims increased by 374,213 (459%) and the cost increased by
505% (General Medical (Payments Board) 2000).
A number of reports between 1996 and 1997 (O’Shea, 1996; Witt, 1996; Irish
Medical News 1997) indicated that public demand for out of hours’ medical care
was increasing. In line with the increased demand for an out of hours’ medical
care, there was a corresponding increase in attendance at accident and emergency
departments over a five year period (Hynes, 1996). A comprehensive 1996 census
of general practice in Ireland highlighted that the average on‐call commitment of
rural general practitioners was sixty six hours per week, in comparison to forty
two hours per week for their city colleagues (ICGP, 1997). Nic Gabhainn, Murphy,
and Kelleher’s (1999) study, on the characteristics of rural general practice,
revealed that 9.94% (48/483) of city based general practitioners accessed
*deputising services for the provision of out of hours cover, in contrast to .18%
(1/531) of their rural colleagues. 7.72% (41/531) of rural general practitioners
were
operating on a one in two rota during the week, with a corresponding rate of
4.97%
(24/483) for city general practitioners.
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