78 Donegal GPs pen letter to Health Minister on patient safety in Letterkenny

Seventy-eight GPs working in Donegal have written to the Minister for Health Mr Stephen Donnelly TD calling for urgent action at the emergency department (ED) at Letterkenny University Hospital (LUH).

It follows on from a meeting with hospital management where they highlighted their patient safety concerns, particularly in relation to timely access to services at the hospital. Hospital management outlined a number of planned interventions at the ED in LUH for this winter. However, the GPs do not believe that the proposed scale and ambition of these plans match the urgent need for fundamental systems change in the department.

“If no significant changes take place, our patients will continue to have unacceptable wait times to access basic emergency care in LUH.”

In an unprecedented move, driven by worsening waiting times at the ED, and for ambulance drop-offs at the hospital before the winter surge, the letter calls for the Minister and senior officials to step in and provide external intervention in the hospital. Similar external reviews have taken place in LUH for other departments, which have resulted in improved outcomes for patients.

“We cannot continue to sit back and watch our patients wait for hours in ambulances at the door of the ED or on hard chairs waiting for treatments. Alternative pathways to hospital services need to be explored. For example, we implore SAOLTA to ensure the hospital has a fully functioning protected medical assessment unit to prevent patients having to attend the ED when they are seeking ambulatory investigations. This would mean that GPs would have an alternative route to arrange urgent investigations for patients without the need to send them to the emergency department.

"This could dramatically decrease GP referrals to the emergency department. This works well in other hospitals across the country and needs to be urgently implemented in LUH” the group said.

“We are worried about the outcomes for our patients in this waiting period, which we know can contribute to worsening morbidity and mortality”

LUH has the longest ambulance turnaround times in the country, meaning patients wait in ambulances before they are seen and are treated by ED staff. The letter goes on to say that the GPs no longer have faith that the current situation can be resolved without external review and intervention.

“We have waited long enough in Donegal for a resolution, and we are prepared to wait no longer. We deserve the same rights of timely access to hospital services as the rest of the country do”.

The unprecedented intervention by Donegal GPs comes as the county faces uncertain times with an expected winter surge in hospital admissions and emergency department presentations.

The full letter reads:
Dear Minister,
We are a group of General Practitioners working in County Donegal. We are coming to you, your officials and others copied into this letter, with grave concerns about the emergency department at Letterkenny University Hospital (LUH). We are seeking an external review and action plan urgently regarding access to the department and acute services.

At the outset let us be clear that this is not about our clinical colleagues who are working under extreme pressure and in unsafe conditions. In fact, it is about supporting them to get the resources they need. Resources also highlighted and requested by our nursing colleagues in recent weeks.

It is not about the standard of care our patients are receiving, but is about the timely access to that care. We have met with hospital management at LUH but believe that the scale and speed of the progress of change at LUH is leading to our patients being placed at risk. We have huge patient safety concerns and while we do not take this decision lightly, we feel that the time has now come to highlight publically the current issues affecting our emergency department and acute services at LUH.

As GPs we are finding it increasing difficult to make the decision to send our patients to the ED. We have to weigh up the clinical appropriateness of sending very sick patients to ED versus attempting to manage them at home, even though in our professional opinion they do require secondary care.

There is a morbidity and mortality associated with leaving patients in waiting rooms for long periods of time untreated, or in ambulances at the door, or on trolleys awaiting admission. We have patients who are refusing to attend the emergency department because they would “rather take their chances” and stay at home. There is a real fear, founded in the reality of other patients experiences, that they will not be seen in an appropriate time frame and instead sit on hard hospital chairs for hours awaiting treatment. Many of these patients are our geriatric population and our hearts sink when we send them to the ED and know the ordeal that is ahead of them.

Patients are leaving and going home, sometimes on the advice of stretched ED staff, as the wait time will be too long. We have huge concerns regarding patient safety here and feel like it is an incident waiting to happen.

Target treatment times for sepsis and other conditions are frequently getting missed based on what our patients and families are telling us. In August, on at least one occasion that we know of, there was no ambulance available in the counties of Donegal, Sligo and Leitrim because they were all waiting for drop offs at LUH for hours. This was in August before the so-called “winter surge”. Our patients are at risk of death and we are no longer willing to stand by and watch while little meaningful change takes place.

We acknowledge the work that is being done locally, often by clinicians and ailed health professionals desperate to improve the system they work in. We welcome the rapid access zone in the ED for assessment and the new clinical arrangements for seeing paediatric patients in the department. We acknowledge the attempts to recruit new consultants and other AHPs, despite the national bureaucracy and roadblocks associated with this. We also welcome the new modular build for LUH which may help to decrease overcrowding, but which will not come on stream for about eighteen months. Efforts are being made, but the ambition, the speed and the delivery is not good enough.

In simple terms, the system is broken. We no longer have faith that the current system can be fixed and appropriately managed without outside intervention, support and resources.

As the Minister we are asking you to intervene with immediate effect in two ways; 1. To meet with us locally, together with senior SAOLTA management so we can all develop a roadmap to providing safer services for our patients this winter. The obstacles we are hearing of from LUH management could easily be circumvented by the Department of Health and the Minister – but only if the will is there. 2. To appoint an external review team to evaluate and provide solutions for the Emergency Department including evaluation of alternate access to acute services at the hospital. This must include GP input and must report back with tangible solutions before year end, backed up by appropriate resources.

As GPs we are keen to be part of the solution, but we need national and regional support in LUH to support the teams there to provide radical solutions to improve access to our emergency department. We also need to improve access to our secondary care teams via other routes. We need someone external to cut through the bureaucracy and put the patient back at the centre of what we are all trying to achieve. We need to be able to send our patients to our local emergency department with confidence that they will not wait for 24 hours on a hard chair to be seen.

Donegal is a unique county in Ireland, sparsely populated, sharing a land border with the rest of the Republic of only a few miles. We have limited private capacity. As a result, we need Donegal-based solutions taking our geographical location into account. This is not the developing world, this is Ireland in 2023 with a huge budget surplus. And Donegal deserves the same access to timely healthcare that patients get elsewhere in the country. If we don’t get that access we will be encouraging and supporting our patients to take to the streets to demand it.

Minister we implore you to take action. We are in this job to advocate for our patients, if you are too, then please listen to our demand for support, before it is too late and more of our patients suffer adverse outcomes.

Your sincerely,
The General Practitioners of Donegal
In alphabetical order;
Dr Paul Armstrong Lifford
Dr Finnian Bannon Ark Medical, Letterkenny
Dr Catherine Blair Donegal Town
Dr Rachel Boner Millbrae, Stranorlar
Dr Mark Boyce Grove, Donegal Town
Dr Victoria Bradley Arranmore
Dr Sarah Brennan Carrigart
Dr Ryan Byrne Scally Medical, Letterkenny Dr Heidy Campusano Donegal
Dr Ronan Cassidy Moville
Dr Eamonn Coyle Ark Medical, Letterkenny
Dr Martin Coyne Lifford
Dr Pallab Datta Ark Medical, Letterkenny
Dr Samantha Davis Falcarragh
Dr Johan Debruyn Gaoth Dobhair
Dr Tony Delap Gaoth Dobhair
Dr Sarah Doherty Inishowen Medical
Dr Thomas Downey Carndonagh
Dr Garrett Duffy Moville
Dr Jarlath Duffy Raphoe
Dr Eoin Dunphy Mountcharles
Dr Catherine Falls Carndonagh
Dr Dan Gill Falcarragh
Dr Angela Gilligan Ark Medical , Letterkenny
Dr Margaret Gilligan King Fanad Health, Tamney
Dr Magdalena Hall Donegal Town
Dr Ryan Hall Stranorlar
Dr Edward Harkin An Bun Beag
Dr Mark Hudson Letterkenny Doctors
Dr Beverly Huss Grove, Donegal Town
Dr Peter Kardos Donegal Town
Dr Jarlath Kelly Buncrana
Dr Sile Kelly Lifford
Dr David Khavia Ballyraine, Letterkenny Dr Gerard Lannon Carrigart
Dr Dervla Loftus Stranorlar
Dr Leemol Mathew Buncrana
Dr Elizabeth Maxwell Milford
Dr Brian McColgan Letterkenny Doctors Dr Shane McCool Scally Medical, Letterkenny Dr James McDaid Scally Medical, Letterkenny Dr Ann-Marie McElroy Moville
Dr Dara McEniff Dungloe
Dr Collette McFadden Lifford
Dr John McGeehan Letterkenny Doctors Dr Padraig McGuinness Fanad Health, Tamney Dr Ciara McHugh Stranorlar
Marie
Dr
Therese McKenna Lifford
Dr Meta McLaughlin Newtowncunningham Dr Charlie McManus Lettermacaward Dr Evelyn McManus Glenties
Dr Aidan McMenamin Moville
Dr Caroline McMonagle Lifford
Dr Magdalena Meges Stranorlar
Dr Janinda Muhandiramge Dunkineely Dr Sally Mullen Stranorlar
Dr Síofra Nic an Bhreithiún Brook Medical, Malin Dr Mona O'Boyle Milford
Dr Emma O'Doherty Donegal Town Dr Ciarán Ó'Fearraigh Millbrae, Stranorlar Dr Raghavan Paratian Ark Medical, Letterkenny Dr Nikola Porter Buncrana
Dr Rajesh Rajpal Buncrana
Dr Supriya Rao Ballyraine, Letterkenny Dr Ciaran Roarty Scally Medical, Letterkenny Dr Dara Scally Scally Medical, Letterkenny Dr John Sheerin Cloghan
Dr Kevinder Singh Letterkenny Doctors Dr Sarah Smyth Falcarragh Dr Ciara Steele Buncrana
Dr Rory Stewart Creeslough Dr Mary Sweeney Milford
Dr Edit Tidrenczel Donegal
Dr Avril Travers Millbrae, Stranorlar
Dr Dolores Vigil Scally Medical, Letterkenny Dr Leon Viljoen Millbrae, Sranorlar Dr David Walsh Rathford, Milford Dr Therese Wheatley O'Neill Derrybeg