Some GP co-ops which provide out-of-hours cover are set for an overhaul which will increase the risk of more patients having to visit A&E departments.
A new value-for-money review of the service which costs the HSE over €100m a year is set to bring in changes in several areas as some co-ops are facing a shortage of GPs.
Around a million patients use the out-of-hours services annually.
The review comes as locals in Birr and Edenderry in Co Offaly met last night to protest at changes in the sudden closure of two out-of-hours GP services.
Tullamore Hospital had 28 patients waiting for a bed as the number of people languishing on trolleys nationally escalated to 595.
The Irish Nurses and Midwives Organisation said 1,718 patients have endured trolley waits in the first three days of this week – up 46pc on the same period last year.
The worst hit yesterday was Cork University Hospital where 64 patients were lined up on trolleys.
Overcrowding was also severe in counties Galway and Limerick.
INMO general secretary Phil Ní Sheaghdha said: “These figures confirm that hospitals cannot cope, the system is unable to manage patient flow and the burden is falling on nursing and medical staff who are forced to work in intolerable conditions.”
Meanwhile, the HSE said the closure of the co-ops in parts of Offaly followed an independent review of the Midoc co-op service.
A spokeswoman said it highlighted concerns about clinical risk, medical emergencies and the problems of doctors working on their own.
“These concerns relate specifically to locum doctors on duty working with no clinical support,” she said.
“It also refers to the ability to manage independently when presented with a medical emergency and the personal safety of the doctor while working alone in Birr and Edenderry.”
Since April 2 last the Midoc service has been operating one fully functioning treatment centre based in Tullamore on the campus of the local hospital which serves Offaly.
“This is broadly in line with the other Midoc centres across the Midlands and were already piloted over the Christmas period and on several other weekends and have worked well,” said the spokeswoman.
“An additional doctor is on duty in Tullamore, during weekends and public holidays from 12 noon to 8pm.
“This will facilitate the more effective management of call-outs and home visits to the entire county, including Birr and Edenderry,” she added.
Local medic Dr Jerry O’Flynn confirmed the review highlighted safety and other issues.
He pointed to the shortage of doctors in rural areas saying this was adding to pressures on out-of-hours services.
The HSE said: “It must be emphasised that there has been no reduction in the total GP clinical time allocated to the Midoc service.”
It insisted there has been no reduction in the total monies allocated for the service from the HSE between 2017 and 2018.