Wednesday 21 February 2018

Don't take advantage of doctor co-ops

Don't take advantage of the out-of-hours service.
Don't take advantage of the out-of-hours service.

Nina Byrnes

Our GP advises against over-using the GP out-of-hours service and what you can do for a child who complains regularly about an itchy bottom.

Question: My daughter was sick over the Christmas period and I brought her to my local GP out-of-hours service. Can I use this as my regular GP service?

Dr Nina replies: Most out-of-hours services are now provided by doctor co-ops. This is where a group of GPs in a particular area agree to provide cross cover for the patients of all their practices in one out-of-hours service. Some co-ops are larger than others but they all function in a similar way. If a GP wants their patients covered by this particular service they must then also work shifts in the co-op themselves.

There are a number of advantages to this service. The patients attending are guaranteed to see a doctor specialising in general practice which provides a recognised standard of care. There is access to GP care outside normal office hours and during weekends and bank holidays.

Most co-ops will send a copy of the consult notes back to your regular GP, so a record of the attendance can also be uploaded to your file. The ease of access and quality of care may make this service attractive to many who may then think that it can be a substitute for a regular GP but this is not the case.

The co-op cannot arrange any investigations such as X-rays or arrange hospital out-patient referral. It cannot send samples such as blood and urine to the lab, making detailed diagnosis incomplete. It cannot undertake services such as cervical smears or routine health checks.

Co-op services were set up to provide emergency cover for illness or injury that cannot wait until you can be seen during the next routine GP surgery hours. Unfortunately as the service has become more widely known many are using for convenience rather than necessity.

GPs working regularly report seeing those with minor illness or those who didn't manage to get the appointment they wanted that day with their usual GP. Many doctors have real concern that as the out-of-hours services become busy with minor illness that genuine emergencies or those who are seriously unwell may not get seen in a timely manner.

I would urge you to only use your co-op for what it is: an out-of-hours service available to provide emergency care to those who are so unwell that they cannot wait several hours to attend their own GP. That way the quality and access to care will remain available to all in an efficient, timely manner.

Question: My eight-year-old daughter constantly complains that her bottom is itchy. We have treated her for worms but it makes no difference. The itch seems to be mainly at the front. What causes this?

Dr Nina replies: Vulvovaginitis is a condition that causes irritation and itch of the vagina or the skin near the entrance (the vulva). This condition is very common in young girls. In the absence of significant oestrogen levels, the skin of the vagina and vulva can be thin and easily irritated. Moisture and dampness of the skin can also irritate or make it easier for infection to take hold. Lastly the use of soaps and bubble baths can irritate the sensitive skin in this area. The presence of thread worm can also cause irritation. This condition is more common in girls who are overweight.

Those with vulvovaginitis usually complain of itch or redness and irritation. There may be some discharge visible in underwear and they may also complain of stinging or burning when passing urine. Medical intervention is rarely required.

If a bacterial infection is found, a 10-day course of antibiotics may be prescribed.

It is important to teach your daughter about genital hygiene. Always wipe from the front to the back. Using damp wipes may help as traces of dry toilet paper left behind can exacerbate symptoms.

Avoid wearing restrictive clothing or tights. Loose white cotton underwear is best. It may be necessary to change underwear during the day to ensure it stays clean and fresh. Wearing a nightdress and no underwear at night can also help in some cases.

Soaking in a bath twice a day may help but avoid using perfumed soaps and washes. Applying a simple aqueous-based cream or one used for nappy rash may also help soothe the area.

The problem will reoccur in about half of those girls affected but it will eventually go away. It is much less common post-puberty.

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