GP Winter Agreement reduces strain on healthcare system

Niamh Cahill reports on how out-of-hours GP services coped during the 2025/26 influenza season

The Christmas and New Year period is always a busy time for healthcare services due to respiratory illnesses.

The 2025/26 influenza season in Ireland arrived earlier and more intensely than usual.

A rise in cases and hospital admissions occurred across the country weeks ahead of the typical winter peak, which raised concerns about the ability of the acute system to cope.

The heightened activity was largely attributable to the A(H3N2) variant.

But the evidence to date suggests that while demand was high, services were not overwhelmed.

IMO GP Winter Agreement

There was reduced pressure on GP out-of-hours services over the Christmas period following earlier than usual implementation of the IMO GP Winter Agreement, according to Dr Ken Egan, Mayo-based GP and Chair of the National Association of GP Co-ops.

Dr Egan told the Medical Independent (MI) that co-ops managed well over the past number of weeks. 

“Getting GPs to do extended hours has made a huge difference and worked very well,” Dr Egan said.

The IMO GP Winter Agreement, which commenced on 8 December and runs until 15 February, was negotiated in November.

It outlined that participating practices provide an additional 20 hours of in-person respiratory/acute clinics over the 10-week period outside of normal surgery hours.

Each consultation during the 20 hours is paid at the special-type consultation (STC) rate of €41.63.

Furthermore, the deal included that each GMS GP in participating practices would receive a grant of €2,500 per GP, while single-handed GPs would receive a grant of €3,000.

A spokesperson for the HSE told this newspaper that extended daytime GP hours commenced earlier in 2025 – on 8 December compared with 27 December in previous seasons. 

Some 1,731 GPs registered to take part in the scheme, representing a broad geographic spread, according to the HSE, with an additional 20,000 hours of GP clinic-time planned.

“Participating GPs submit planned practice clinics to the HSE every Monday via an online form and advertise the clinics online and to their patients.

As of 11 January 2026, over 70,000 additional patient contacts had taken place, the spokesperson said.

Out-of-hours GP co-ops commenced on 27 December and were due to run until 26 January 2026. “Provision has been made for 20,000 additional GP/nurse/triage hours. As of 4 January 2026, over 3,100 additional rostered hours have been reported.”

“The early commencement and communication of daytime GP extended hours have significantly increased access for patients through the GP system, promoting early management of respiratory presentations and supporting reduced emergency department attendances.”

NEDOC

According to NEDOC Operations Manager Ms Arlene Fitzsimons, demand on the service, which covers Meath, Monaghan, Cavan, and Louth, was similar to that experienced in 2023.

“We had as busy a Christmas [as in 2023]. But we had really anticipated a high volume of calls. We knew the flu season was about to peak Christmas week coming up to Christmas Day,” Ms Fitzsimons told MI.

“We had additional resources to manage the anticipated demand and that resulted in fewer delays in callback times and appointment times. So while there were some delays, there were not as many as there could have been because we had so many additional resources on hand. That included additional GPs, call handlers, supervisors. It was a fantastic team effort.”

From 24–29 December (Wednesday evening until Monday morning when GP surgeries reopened), over 2,300 patient contacts were recorded. GPs managed over 1,800 of those contacts or 78 per cent, Ms Fitzsimons said.

On St Stephen’s Day, a total of 720 patients contacted the service and 78 per cent of those were seen by GPs.

On New Year’s Day and over the following weekend, NEDOC recorded 1,700 patient contacts and around 1,300 of those were seen by a GP.

“At this stage we feel the flu season has probably peaked. Even though schools are returning it usually doesn’t bounce back up, but instead continues declining,” Ms Fitzsimons said.

“We had really high levels of patients presenting with respiratory illness across all age brackets and about 10 per cent of our cases were really urgent. The rest of the cases were routine.

“We had very few red-eye [overnight] sessions that were really booked up through the night. In previous years I’ve had sessions booked through the night in busy centres in Navan and Drogheda and that didn’t happen this year.”

Ms Fitzsimons explained that planning for surges in demand over Christmas was better this year than in previous years.

“For the last few years there has been an agreement between the IMO and the HSE, but it has come so late that it has had limited impact on the out-of-hours. But this year they came to the arrangement earlier, so GPs were able to plan before Christmas and that definitely helped in the out-of-hours.”

However, Ms Fitzsimons attributed the ease in pressure at NEDOC to a combination of factors overall.

In addition to the extension in daytime hours, she pointed to additional resources put in place by the co-op, and improvements to the NEDOC phone system.

“There had been problems with dropped calls and this was leading to patients ringing and ringing and clogging up the phone lines. We put a new system in place and that meant it was easier to get through.”

Vaccine

According to data from the Health Protection Surveillance Centre, influenza vaccine uptake among vulnerable populations in the community is higher so far this season compared to the previous season.

Data from 15 September to 4 January shows a 24 per cent vaccine uptake among children aged two to 17 years compared to 19 per cent uptake last season.

Among all adults aged 60 years and over, the uptake was 65 per cent compared to 61 per cent last season. More healthcare workers received the flu vaccine compared to last season, the data shows.

Prof Ray Walley, Department of General Practice, University College Dublin, described the GP deal as “sensible”.

However, he argued that arrangements to provide extra clinics in surgeries during winter months and during peak periods of respiratory illness should be put in place even earlier in future to allow GPs to plan better.

Prof Walley suggested that the HSE and Department of Health should take a more “proactive” approach to winter planning overall.

He also questioned why the respiratory syncytial virus (RSV) vaccine, administered to protect against spread of the common virus which circulates every winter, for example, is not given to older adults here in a similar manner to the UK.

The vaccine is available to babies born in Ireland during winter periods; however adults who wish to receive the vaccine must pay for it.

HIQA is currently undertaking a health technology assessment and public consultation process to determine whether publicly funded RSV immunisation for infants more broadly and older adults should be in place in Ireland.