What comes next will unfortunately be completely different for both patients and doctors
– wrote Tahitótfalu GP Zsombor Magyar in a public Facebook post intended as a farewell after the doctor had to close the doors of the general practitioners’ duty service centre, which had also provided on-duty healthcare to surrounding settlements, on 31 January.
I can confidently state that when it came to the most important, most beautiful, and most difficult goal of our duties – saving lives – we had been striving to perform at the highest possible level. In cooperation with the National Ambulance Service (or in its stead, as it was sadly often the case in recent years) we managed to provide first-line care to countless patients in critical condition, saving many lives thereby
– continued the ostensibly shaken doctor.
Among the locals, immense outrage followed the announcement that as part of the Pest County GP duty system’s on-going restructuring, Tahitótfalu’s on-duty service would cease to operate from February 1 onwards. Since that date, it’s the Szentendre medical centre that performs on-duty service for the village’s residents, in addition to patients from Leányfalu, Dunabogdány, Visegrád, Kisoroszi, Pócsmegyer, and Szigetmonostor, all under the coordination of the National Ambulance Service.
Although officially, the Szentendre centre was already the one operating the duty service on February 1, Zsombor Magyar was still attending to a patient with gastric bleeding in the Tahitótfalu office at three in the morning that day – the GP’s operating license had expired at midnight. “The National Public Health and Medical Office Service called to ask about my plans after midnight. In turn, I asked what the ambulance service was planning, but it turned out the National Ambulance Service had no plan either. It was obvious that we would be allowed to stay there until 7 AM despite the expired license” Fortunately, the patient’s condition was not critical, and after on-site treatment, a family member took them to one of Budapest’s hospitals.
An alliance for the duty service
Outraged, the residents of Tahitótfalu and the surrounding settlements created a Facebook group with the intention of collecting signatures a few weeks ago. Within a few days, nearly three thousand people had signed the petition. Supplemented with a hundred-page document describing the locals’ position, the petition was delivered personally to Fidesz politician Eszter Vitályos, the district’s parliamentary representative. The team behind Tahitótfalu’s civil alliance told our newspaper that they would not stop at this, and signatures are still being collected both online and at signing points throughout the region’s settlements.
They went on to add that trusting the strength of the previously unprecedented civil movement in the region, they believe that the unanimous opinion, request, and voice of the thirty-five thousand residents of the region will be able to change the already introduced modification so that the seven municipalities can continue living in the sort of safety they were accustomed to.
Instead of the previous seven, the duty centre in Szentendre covers roughly twice as many municipalities since February 1, serving orders of magnitude more residents than the previous 35 thousand.
The civil movement’s team also drew attention to that besides the significantly increased number of potential patients, distance from the medical centre is also an important factor, which may hinder safe care. The previous duty centre in Tahitótfalu was located right in the middle of its serviced region, and in case of an emergency call or a visit to the office, the longest possible distance – to Visegrád – was 12 kilometres.
This distance doubled on February 1, posing a daunting and time-wise potentially impossible challenge to both patients heading to the clinic and duty personnel responding to emergency calls during evening rush hours and weekend traffic jams
– they told 24.hu.
According to residents of the surrounding settlements, the issue is not about people being lazy and unwilling to travel greater distances for care. Rather, they are concerned that help may not be able to reach the mountain-side properties – which are often difficult to access due to adverse weather or road conditions – in time. This was pointed out by Erik Ádám, founder of a civil society organisation in the Danube Bend. Both Erik and his wife are Tahitótfalu residents, and both of them struggle with cardiac problems, and there were many instances when the visiting duty doctor ended up calling an ambulance for them. The couple lives on the hillside, and the vehicle of the duty service could always easily access their location, even in muddy conditions.
Restructuring is necessary – but not like this
Tahitótfalu GP Zsombor Magyar explained to 24.hu that he considers a nationwide restructuring of the duty system justified by necessity, but he finds the current implementation rather concerning. In Tahitótfalu – as in most places before the gradual introduction of the new system – the GP duty service was organised within a business framework. Dr. Magyar does acknowledge that some of the companies, operating hundreds of such duty centres nationwide, would provide services of extremely heterogeneous quality. What the GP takes issue with is the way this transformation is being carried out:
Zsombor Magyar took over the Tahitótfalu duty centre six years ago. Although the National Health Insurance Fund Administration (NEAK) did provide normative support for registered residents, the amount was not enough to maintain the operation, so the municipalities involved decided to pitch in for the financing of the duty service. The system was so underfunded that in the years leading up to the restructuring, it was the municipalities themselves that covered half the amount needed for the duty service’s continued operation.
On average, it takes the ambulance eighty minutes to arrive
It’s not only the residents who are worried – Zsombor Magyar is also feeling uneasy.
My problem isn’t that my business won’t be able to operate the service any more – I’ll get by without it. It’s the patients that will be worse off, as the region is in a very bad situation in terms of ambulance capacity
– he says, adding that the National Ambulance Service would call them several times a week to request going to a patient, as the ambulance could not make it.
As the most extreme example, he recounted an instance when a patient from nearby Kisoroszi was taken to Budapest by an ambulance coming from Nyírbátor, a settlement more than 200 kilometres to the east.
In Central Hungary, there are roughly half as many ambulances as needed. There aren’t enough emergency vehicles, or it’s that the ones that are available are too far away. That’s why, in recent years, it has been common for ambulances to take 60-80, but in some cases 120 minutes to arrive instead of the standard 12 minutes
– tells us the general practitioner, whose patients were reached by the ambulance in an average of eighty minutes, according to his calculations.
He adds that his duty doctor business used to be familiar with local conditions and patients. As a general practitioner of Tahitótfalu, he has a connection to both the place and the patients, just like the other doctors in the surrounding areas providing duty services.
It was a great team; some had been working here for forty years.
As he explains, he himself will provide the same service in Szentendre without hesitation; but those GPs who haven’t taken any shifts on the duty roster so far will now be forced to do so – however, these doctors lack the ‘professional freshness’ and experience necessary for the care of emergency patients.
Another thing Dr. Magyar finds problematic is that the decision regarding the duty service centre being in Szentendre had been made merely two weeks before the shift; and instead of the four duty doctor service points formerly in the town, there will be only one from now on. Four times the area, one-quarter of the capacity – he summarised the situation. The very first notification regarding the new duty centre launching on February 1 had arrived on December 15. He also laments that this drastic step was taken without professional consultation.
I wish sincerely from my heart that the new duty system would work well, as that would be best for everyone
– says the doctor, who believes that the new system will surely be functional – for better or worse; although in his view, the reduced capacity will probably lead to difficulties in some cases.
Widespread dissatisfaction
It’s not just Tahitótfalu and its surroundings that resist the restructuring. On January 26, residents of Pomáz organised a honking protest against the new duty GP system. The old duty centre of the Pest County town with 20,000 inhabitants also ceased to operate on February 1, ending 36 years of service. 42,000 residents belonged to the former centre from Pomáz and its surroundings, but from now on, some will have to travel to Szentendre for duty care, while the rest will have to go to the Pilisvörösvár office. In reply to questions by TV channel RTL’s news service, the National Ambulance Service stated that the new system was devised following a meticulous analysis, while further analyses will be carried out during operation to ensure patient safety; additional changes to the system may come if needed.
Budaörs residents are also unhappy about their local duty doctor’s office ceasing to exist from February 1 after more than twenty years of service. In the case of Budaörs residents needing medical attention outside of GP-hours, they will now have to travel to Budakeszi or Érd. Similarly to Tahitótfalu, the Budaörs municipality – jointly with Törökbálint – would continue to finance the service from their own resources. Mayor Tamás Wittinghoff told RTL that there is currently no legal option for Budaörs residents to receive duty care locally from February 1 onwards. According to the National Ambulance Service, the operation of the duty service is entirely in their jurisdiction, so there is no need for the municipality to continue providing healthcare services voluntarily at its own expense. This somewhat contradicted Gergely Gulyás’ statement at last week’s governmental briefing session replying to whether the municipality could continue to operate the service at its own expense. The Minister of the Prime Minister’s Office stated the state cannot intervene regarding the establishment of a private medical centre; this is well within the municipality’s rights.
Restructuring process nearing completion
Under the coordination of the National Ambulance Service, the new unified duty system for primary care made its debut in Hajdú-Bihar County on January 1 last year, following a longer trial period. The essence of the new system is that patient care is conducted under the direction of the ambulance service rather than the municipalities, with fewer duty care locations. Patients can personally visit these locations on weekdays from 10 PM to 8 AM and on weekends from 2 PM to 8 AM the following day. Outside these hours, patients need to ring the emergency number 1830. In these cases, it is the dispatcher who then decides whether advice transmitted over the phone is sufficient, or if a duty service vehicle needs to be sent out. In cases of life-threatening conditions, the dispatcher can also call the ambulance.
The nationwide expansion of the unified primary care duty system continued with Fejér and Pest counties on February 1, with only Budapest remaining by now.
Last February, the restructuring process stood in the centre of attention following a statement from the Hungarian Medical Chamber urging GPs not to sign their contracts with the National Ambulance Service, which gave the implementation of the new system a difficult start in several counties. The Medical Chamber’s statement was issued because the organisation feared that the new healthcare regulations introduced in January last year would further diminish the quality of medical service and jeopardise patient care.
On its website, the National Ambulance Service claims that the new system is functioning seamlessly everywhere. They add that for typically milder health problems, duty care has provided an appropriate solution in over 90% of all cases, with 19 105 patients needing further, specialised treatment or hospital admission. Telephone advice sufficed in over 32,000 cases. More than 246,000 patients have been given care at one of the duty service locations, while 21,000 were treated at home by duty staff arriving with a service vehicle. Of those having received primary care, 37% were children and teenagers under 18.
The emergency number 1830 is functioning well all over the country, and based on feedback, patients remain satisfied with the duty system
– writes the National Ambulance Service.
