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Cancelled operations and non-urgent visits waste GHA resources, director general says

GHA Director General Professor Patrick Geoghegan addresses a public meeting of the GHA Board in Charles Hunt Room, John Mackintosh Hall. Photo by Johnny Bugeja,

Almost half of those who attend A&E are non-urgent cases and around 60% of cancelled operations were called off by patients, the GHA’s Director General Professor Patrick Geoghegan said, as he stressed the strain this puts on healthcare resources.

Prof Geoghegan was addressing a public meeting of the GHA Board on Tuesday evening and stressed that the GHA’s resources were there for the public to call on whenever necessary.

But he highlighted too the heavy demands on healthcare services and the need to use them sensibly.

By way of example, he said the Primary Care Centre sees between 12,500 and 13,000 patients a month.

“That is a hell of a lot of people to see,” he said.

“And I said to you before, if that's not meeting the needs of the people of Gibraltar, we must have a very sick country.”

“We don't have a very sick country, it's how do we use it sensibly?”

He hopes the new Mobile Health Unit will be able to cater to people who need advice, leaving appointments for people who genuinely need them.

Prof Geoghegan, in his last meeting public meeting of the GHA board, said resources need to be better managed by the public too.

“Resources are very scarce,” he said.

“No system in the world can waste health resources because we don't have all the resources you would like.”

In another example, he said 46.6% of attendances at Accident and Emergency were non-urgent cases.

Prof Geoghegan said that those who are non-urgent may need to wait 89 minutes, whilst an urgent case will be dealt with immediately.

“The non-urgent people who attend it's just 46.6% of people who come in who don't need to be there,” he said.

As well as over 1,000 operations cancelled by patients, Prof Geoghegan said, another 400 operations were cancelled by the GHA due to the patient being medically unfit and, previously, due to theatre packs being contaminated under the old unit, and this issue has now been rectified.

“But nevertheless it's 60% [cancelled by patients]. Not the GHA, not the doctors, not the nurses, not the therapists. These are people who don't turn up and yet we even ring people and say, ‘don't forget about your theatre appointment tomorrow’,” he said.

Looking ahead, Prof Geoghegan said that over the next month or so, he hopes to finish off the three-year strategic plan for the GHA.

The plan will introduce a new framework, an estate strategy, workforce strategy and will provide clinical service plans.

“At least the board has a plan that we can work to for the future, but there are going to be challenges,” Prof Geoghegan said.

“It's a big piece of work.”

Prof Geoghegan also pointed to an announcement soon regarding the MRI service in the GHA.


Prof Geoghegan found that GHA waiting lists for operations included people who did not actually need the procedure.

In many instances, patients had their names put down in the eventuality that they may need the operation, which in turn created excessive demand for the service.

For example, Prof Geoghegan found that nearly 100 people on the waiting list for a hip replacement or knee replacement did not need one.

“Some of them have recovered, some of them don't want to have it now, some of them are medically unfit, so they can't have it,” he said.

He explained this causes an issue when prioritising what services need to be met.

“That's where we will need the help of the public as well, because we're writing out to everyone and saying to people on our list, ‘are you still waiting for a procedure?’” Prof Geoghegan said.

“Some people, it amazes me, have said ‘not really. I've got referred because I thought if I put my name down now and I have a bad hip, in two years’ time I get my operation done’.”



Prof Geoghegan reminded the public that appointments can be made online, rather than calling every morning.

“Our new phone system is in place and despite us saying to people ‘you don't have to rush in the morning now for everyone to ring to make an appointment’, we're still having about 150 to 200 calls between 8.15 in the morning and 9am,” he said.

“So it's almost impossible for our staff. We put extra staff in, we put extra phones in, we just can't do it.”

“So that's why if you ring around that time, you could wait for about 18 to 20 minutes for the phone to be answered. If you ring after 9am, [at] 9.15 - because we record all of this - you could only wait for about three to five minutes.”

“So again, we're just saying to people, try and use the phone sensibly so you can get what you want and can get a named GP as soon as possible.”

The PCC also sees around 4% of their appointments resulting in non-attendance, resulting in some 5,500 appointments lost annually.


The Children’s Health Centre recently became the base for doctors’ appointments for children, rather than in the PCC.

The service opened on March 6, with two GPs and 60 appointments offered a day.

But, so far, just 43 appointments are being used daily with some people choosing instead to have their children seen at the Primary Care Centre.


The mortuary service will return to the GHA following “tremendous pressure”.

“I understand people are very passionate about how they look after their loved ones,” Prof Geoghegan said.

“We've decided we will reopen our mortuary and have two viewings here.”

“We're just in discussion now with the bishop and priest about the chapel and where we can relocate the chapel, so we still have a place of worship. I think that's important. “

Prof Geoghegan reflects on year of change for GHA

Director General Professor Patrick Geoghegan looked back on “the good, the bad and the ugly”, as he held his last public meeting of the GHA Board, before he steps down from the post.

Earlier this year, Prof Geoghegan announced he would be leaving the GHA after he was diagnosed with prostate cancer, and Tuesday evening marked his last appearance at a public meeting.

The public meetings are set to continue after the trial period has come to an end, but before his departure Prof Geoghegan said he has seen progress in the GHA.

“I have to make hard decisions,” Prof Geoghegan said.

“Sometimes people don't understand, sometimes we get it wrong, and I'm the first to say I got it wrong.”

“It's quite sad because I think we're on a journey that's now taking off. When you see the achievements in the last few months, and it's not just happening because I'm leaving, this is all planned in the pipeline, because, as you know, I wasn't planning to leave because of my ill health.”

Prof Geoghegan added that if the GHA continues on this path, he can see its health services become a centre of excellence.

“I'm always known as a troubleshooter. Even in the UK and wherever I've worked internationally, I always come into organisations that are having difficulties or being challenged, and I enjoy that,” he said.

“I get bored if everything's going too well, I like to win. I'm a real turnaround agent and yet there were things here that was easy to fix.”

“We had to fix the mental health strategy. People shouldn't be going into hospital. We had to change primary care so people can get the phone answered and be seen by their GP, etc.”

The meeting saw questions brought forward by the public, with some thanking Prof Geoghegan for his work and changes they have seen, despite pointing out the need for further measures or changes.

“I think that's what you do as a leader… you win the respect of people, you work with people and you give them the right to challenge you,” he said.

“I never get upset when people challenge me, because I question myself and say, well, have I got it wrong? And if I get it wrong, I change it. And I think leaders who fail are people who think, ‘Well, I'm right, right?’ No. Often, 90% of the time, the patient is right, if you listen.”

“Sometimes we get locked in our professional barrel and we don't want to change, and that takes the energy out of an organisation. I'm far better. I want to be a dynamo rather than a dinosaur. Just keep going.”

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