I shall start by responding to Deputy Reilly. We did not benchmark attendances at accident and emergency departments when we developed co-operatives although that might be something we should do. Obviously, a patient will go to the most appropriate care. I agree with the Deputy that there should be Garda vetting for locums. In the review we introduced a standard service level agreement with the various co-operatives which, as members know, are private companies run, in the main, by general practitioners. Part of that service level agreement includes our insistence on Garda vetting for locums.
In regard to Caredoc-DDoc, I presume the Deputy was referring to a contract which was set up when DDoc started. There was anticipation of a huge demand and, as members know, we set up the scheme rather quickly and got a contract of €1 million for the year. Obviously, that has proved to be rather expensive, at about €24 per call so we have tendered to the EU procurement body for triaging, which should be agreed before the start of the new year.
Although it varies, the satisfaction level is 95% plus. We asked departments of public health in our local offices to look at the level in detail and it is probably the highest satisfaction rate of any services we provide. The idea behind the review was to standardise. As Senator White noted, the scheme started off at varying degrees or levels throughout the country, beginning in Carlow town. It then spread to the north east, where I had been involved years ago, and operated as a region. It moved west and then back to the south. The last service to open was DDoc in Dublin. The idea was to have a standardised approach.
We looked at the number of call centres and in that regard there was one thing we did not want to do, not for a minute. In a call centre the patient telephones, details are taken by a telephonist and the patient is telephoned back by a nurse who triages the call. It would not matter whether we had one, seven or four call centres. The idea in having four is to have one per region so that we could use the call centres to develop other services during the day.
I move to Deputy O'Sullivan's question. It is hard to say which co-operative works best because all have their strengths and there are very few weaknesses. When we were preparing this review, which I chaired, we went around the country and met all the co-operatives. There are lessons to be learned from each one. There is an Irish association of co-operatives and they meet and learn from one another. We came across nothing that would concern us. Quality is very high.
Points were made about DDoc being in crisis and that we would not meet it. Members of management for Dublin north-east met DDoc the other day and discussions are ongoing to have a service level agreement for January.
We were asked about the call centres in the west. There is a problem of management because of the size of the region. Currently there are three call centres, in Galway, Limerick and Donegal. We have left the regional directors to deal with this and we may end up having three virtual centres with one management structure. We do not necessarily say we will close two but it will be a matter for the regional director.
There was a question about drivers. Of all the questions we put to the various GPs, the one thing that emerged was that there is no alternative. They want to have drivers and we agree with them. We asked the regional directors to look at the length of time drivers are on call. For example, the other night in north Dublin we had two drivers working for the entire night.but no home visits were made. That was not value for money at its best. As Deputy Twomey knows, general practitioners go out at certain times during the day to do house calls. We suggest having a lesser time involvement for the drivers but they should be made available because even from a health and safety point of view there is a requirement at night to have somebody along, whether the doctor is male or female.
Deputy O'Hanlon asked about the fee per item with which I am sure he is very familiar. In the north east and in Dublin we pay a grant regardless of the number of calls doctors make. We find that not to be great value for money. The fee per item is currently €60 per visit for a GMS patient.
We already met representatives of the Irish association of co-operatives. Dr. Daragh O'Neill, the association chairman and a member of North East Doc, met us. Mr. Burke and I met the representatives in the Irish Medical Organisation the other day and went through the 13 recommendations. They were quite happy with our initial discussions. Regarding staffing levels we have asked the regional director offices, RDOs, to look at that matter.
There was a question about the 75 treatment centres. We did not, for one minute, recommend that they be closed but recommended a visit to see if the centres have patients in sufficient numbers. During this review there was not much time to look at 75 different places throughout the country so we have asked the regional directors to ensure that patients do not have too far to travel. The number might go down to 70 but geography is key, especially in places such as Cavan and Monaghan. We do not want to have people with children travelling too far in the dark. There may be too many centres in some towns but not enough in rural Ireland. That was the idea behind the review of the treatment centres. It was not with a view to cutting them down.
Senator Prendergast asked about drivers. When I started off the co-operatives we wanted to have a blue light service but the Garda advised us that only their vehicles and ambulances are entitled to have a blue light. We put a green light on top of the cars to distinguish them but they are not allowed to break any speed limits. In Dublin they are allowed to travel in bus lanes but cannot break the speed limit in them. This is not an emergency service but what is termed an urgent GP primary care service. There is a distinction. If a call comes into a GP co-operative which is deemed an emergency the co-operative immediately has access to our ambulance service and work hand in glove with it.
I agree with Senator Twomey that we would not have been able to start this service without the developments in IT. It would not have worked, as the Senator will remember from his old two in one rotas. There has been a huge development and we will develop it further. We spoke with the IMO last week and Dr. Boland gave us a few good examples of how we could improve service. For example, rather than sending faxes and reports to GPs we would do this electronically.
The reduction from grants to fees will save roughly €7 million and the reduction in call centres we will save about €2 million so in the current year, with the tightening up of drivers' hours we hope to save about €10 million.
In regard to the point Deputy Aylward made, we have been trying to get 100% cover since 1999 but we have identified only four large towns - Limerick, Sligo, Dundalk and somewhere in the midlands. They have not come forward yet but discussions continue. I presume local medical politics plays its part. There is a reason it has not happened but it is definitely on our agenda to have 100% cover in due time. As the Chairman said in his closing remarks, such coverage is one of our successes even though it existed before the HSE started. It was there in the time of the former health boards.
I turn to the Chairman's comments on STCs and might ask Mr. Burke to cover some of the other aspects. An STC is a special type consultation for which a GP gets paid when he sees a medical card patient out of hours. Approximately 300,000 medical card patients are seen out-of-hours and there is a charge of approximately €60 for those consultations, whereas the grant was paid whether or not doctors saw patients and proved to be quite expensive. I presume Mr. Burke will comment on his audit, which he has with him. All of these payments are paid through the primary care reimbursement centre. I do not have the detail of every claim, but may be able to provide that to the committee. As mentioned, doctors not in the co-op hope to get their claims in as soon as possible. It is our intent to ensure triage is as near as possible or connected to GPs, so that it is a GP-managed or GP- led nurse triage rather than a doctor triage, which is much more expensive.