Trust issues guidance to local GPs on bypassing SWAH

THE WESTERN Trust has now issued guidelines to local GPs on when local patients should bypass the SWAH, in light of the suspension of emergency surgery at the hospital.

The letter details a wide range of conditions that should now bypass the hospital, including those with scrotal, abdominal or hernia pain, those with post-operative complications.

For example, anyone over 55 with abdominal pain will be advised to bypass SWAH by their GP, while children under five who need surgical assessment will be referred to Belfast.


Local councillor and GP Josephine Deehan said local GPs received the letter from Trust medical director Dr Brendan Lavery yesterday, after previous communication regarding patient pathways was made from the Trust to local GPs through the Western Local Medical Committee.

“It’s quite a detailed document, we received that yesterday afternoon,” said Dr Deehan, who explained what was in the letter.

“As you know, the temporary suspension will commence from Monday (December 5th).

“There will be two surgical ambulatory assessment units. There is one in Altnagelvin Area Hospital, which opened on November 21st , that’s based in Altnagelvin, and there will be one in Ennsikillen, in the SWAH, and that will open from Monday, December 12th.

“They have sent us through quite detailed guidelines regarding which patients should be sent to Altnagelvin or, for children under five who have an acute surgical emergency, they should be sent to the Royal Belfast Hospital for Sick Children. Also, the ambulance service, if they are called to a major trauma, it states the emergency department in SWAH will still function as a major receiving unit.

“There are some exceptions to that, such as where there has been a penetrating trauma, but the ambulance service will use a triage tool which has been developed by the major trauma service. The ambulance service will then decide whether to bypass the SWAH.

“Of course then, if you have somebody with gastrointestinal bleeding, they will also bypass SWAH ED.”


Dr Deehan said the medical committee had been liaising with the Trust regarding GPs’ concerns on the suspension of emergency general surgery, “Our focus really is patient safety. The guidelines produced by the Trust are designed to optimise patient safety.”

When asked if she felt the new arrangements were safe, Dr Deehan said, “In the case of life-threatening emergencies, there is no one who can guarantee absolutely that the patient will not come to harm, given they have to travel increased distances. But I do feel these guidelines go some way in providing reassurance.”

When contacted about the new GP guidelines, a spokeswoman for the Trust said, “Communication to GP’s also took place on 17 November, providing broad guidance with a review to regular updates.

“A communication with guidance on Surgical Ambulatory Assessment in SWAH was sent yesterday (1 December 2022). This has been sent through our local GP Communication channels; to GP AMD and representatives of Western Trust Local Negotiating Committee, who distribute to all GP’s in the local area.”

They added, “Whilst disappointment was expressed during the initial meeting (15th November) there was broad understanding of the staffing issues.

“Staffing difficulties have been well known to the local GP’s and they were content that considerable work was happening to mitigate the changes.

“We will continue to engage with our GP colleagues around the temporary unplanned change to Emergency General Surgery at SWAH.”

Cllr Donal O’Cofaigh, who is part of the Save Our Acute Services campaign which is holding the major rally in Enniskillen this evening (Friday), said the details of the new letter were “concerning.”

“This is very concerning in so far GPs have now being given guidance as to when patients have to be bypassed from the doors to SWAH all the way to Altnagelvin or Craigavon,” he said.

“There are obvious concerns as to how this is going to impact wider acute services, because it’s not simply a case now of just emergency general patients but other patients maybe bypassed.

“We’re seeing real moves now for a post emergency surgery scenario at SWAH, with the opening of an ambulatory assessment unit.

“I’m hearing very worrying reports that other surgeons in other specialisms are considering their future at the hospital.”

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