POLITICIANS who have vouched for the continuation of Clonakilty’s SouthDoc service may not know the full story, according to a West Cork medic.
BY JACKIE KEOGH AND KIERAN O’MAHONY
The doctor – who asked not to be named, for fear of a backlash – said the politicians would ‘do better to speak to local GPs’ to clarify the actual situation. ‘The people in Clonakilty deserve better,’ he added. He said the issue is not whether the service is closing or not – but whether it is still offering appointments at Clonakilty.
The medic explained the premise of the service saying: ‘SouthDoc is a co-operative of GPs who have a collective responsibility to make arrangements for maintaining their patients’ care when their own surgeries are closed, such as evenings, nights and weekends.’ That means GPs have a contractual obligation under the General Medical Services (GMS) and medical card scheme to provide out-of-hours care.
The divergent comments in an article in last week’s Southern Star were ‘technically correct, depending on interpretation,’ the GP stated.
Politicians who said the Clonakilty treatment centre is not going to close in December are ‘technically’ correct, the doctor added. But that comes with a warning that the management of SouthDoc might no longer offer appointments at the centre in Clonakilty, preferring instead to offer appointments in Bandon and Bantry. Although specific arrangements will be made for house calls, most patients needing to see a doctor could be directed to the nearest base in Bandon.
The doctor said closure by stealth has occurred in other places. ‘Similar situations arose in the past with the Kinsale and Dunmanway treatment centre and, more recently, the Skibbereen and Macroom treatment centres.’
The medic also made the claim that no patients have been seen at any of these treatment centres in the last year, or more, yet they still appear on the map of treatment centres on the SouthDoc website and are, therefore, ‘notionally there.’
It was pointed out that SouthDoc has a service level agreement (SLA) with the HSE to maintain a level of activity, and thus maintain a funding stream from the HSE.
As long as these centres are maintained, it appears that the SLA is not being breached. Another factor in the SLA is the number of patients treated, but it’s not specified where these patients must be seen. ‘Therefore, if appointments are only offered in Bandon and Bantry, and sufficient numbers of patients are treated, the SLA is not breached,’ the doctor stated.
In this regard, GPs are not technically breaching their obligations under the GMS and medical card services contract, as an alternative exists for when their own surgeries are closed.
‘Having an alternative means that the HSE spokesperson was correct in saying that there has been no change in the provision of services, as far as they are concerned,’ said the source.
It was pointed out that SouthDoc treatment centres generally operate out of primary care centres. There is no rent, or lease, but rather an agreement that SouthDoc has the use of specified rooms in these centres. The way it works is that rooms, which are used by dieticians and occupational therapists during business hours – from 9am to 5pm from Monday to Friday – are made available to SouthDoc outside of these hours.
‘It is not difficult for SouthDoc to say that they are maintaining treatment centres when these rooms remain at their disposal under an ongoing loose arrangement, but whether those rooms are actually used to treat patients is another matter,’ he said.
The fact that the Bandon treatment centre has been renamed the ‘South Cork Treatment Centre’ and Bantry has been renamed as the ‘West Cork Treatment Centre’ is indicative of what is to come, according to the doctor.
Comparisons have also been made between the existing service and the early days of the Clonakilty SouthDoc Treatment Centre. When it opened, more than 20 years ago, it came equipped with a doctor, a nurse, a receptionist and a driver at its disposal, during daytime weekend hours.
After the Covid pandemic, it was alleged that the HSE began to refuse to process claims for out-of-hours consultations that were not made through co-ops like SouthDoc. This had the effect of defunding Saturday morning GP clinics in West Cork, making them unviable.
And within a year or two, a lot of them had disappeared altogether, leaving SouthDoc the only option for patients seeking GP care in West Cork at weekends.
The doctor claimed that in recent months the Clonakilty treatment centre has been closing at 6pm on Saturdays and Sundays, with appointments after this time being offered at the ‘South Cork’ Treatment Centre in Bandon.
‘The next step,’ according to the medic, ‘appears to be to no longer offer appointments in Clonakilty, where only a few years ago, a new primary care centre was opened to deliver enhanced services to the local population.’ It is acknowledged that GPs are under pressure and many cannot keep pace with the ever-increasing demands of the out-of-hours service along with their busy daytime practice.
The rise in demand can be seen when one compares the 162,000 patient consultations processed by SouthDoc in 2006, to 231,000 in 2022.
GP numbers have not kept pace with the growing population. ‘If GPs cannot maintain existing services, surely their GMS contract with the HSE to provide care for medical card holders is the real problem?’ he asked.
At this week’s Council meeting, Cllr Alan Coleman (Ind) warned that the language being used by HSE officials makes no reference to maintaining a presence in Clonakilty. ‘The language being used is similar to what was being used about SouthDoc in Kinsale a few years ago, when it was in trouble. We were assured that it would be maintained but what transpired was that the facility closed in Kinsale and the service was provided from Bandon,’ said Cllr Coleman.
He called on Cork County Council to write to SouthDoc, the HSE and the Minister for Health, on the issue.
Cllr Daniel Sexton (Ind Ire) said three medical professionals had contacted his party leader about their concerns.
Meanwhile, Cllr Ann Bambury (SD) said Bandon already caters for Kinsale, so it’s vitally important the Clonakilty service remains intact.
On Wednesday afternoon, the HSE issued this statement: ‘The current SouthDoc Out of Hours (OOH) service provided at the Clonakilty treatment centre remains the same. There are no planned changes or closures; the building remains in place and SouthDoc services will continue to run from that location. SouthDoc will continue to offer appointments at Clonakilty in the same way as it does currently.’
