GP cuts will strangle our future health service
GP cuts are incredible given the Government’s focus on community care and de-institutionalisation
The Vision for Change policy is also about integrating health and social care in the community for mental health service users. Likewise, the HSE has been planning to discharge people with disabilities from residential settings into the community as per its Time to Move on from Congregated Settings report of 2011.
It has arrived at a four-tier integrated services model which spans primary care, social care, secondary hospital and tertiary hospital care. The lynchpin in all these policies is the role of GPs. They will be key to providing and staffing the primary care health centres which have only started to be rolled out and which are key to keeping people from being admitted to acute hospital services or institutional care.
GPs will be the first port of call and will not just work within a primary care team (level one) but also liaise with the myriad of other health and social care services in the health and social care network (level two); secondary care hospitals and urgent care services at level three; and tertiary care services, the “centres of excellence” at level four.
Indeed, the HSE is implementing policies whereby smaller county and general hospitals will cease to perform complex health procedures and will be “reconfigured” as day hospitals/urgent care centres or clinics.
Reducing the need for hospitals
All of these will be linked to primary and community care, with the stated aim of reducing the necessity for people to stay overnight in acute hospitals or even need hospital care in the first instance.
Other interventions such as “falls clinics” in the community for older people and enhanced geriatric community care, all liaising between primary care teams and health and social networks, are designed to keep people from being admitted to hospital or having to go into nursing homes.
Meanwhile, community mental health teams are planned, to liaise with primary care teams to fulfil the gold standard of keeping patients with mental illnesses at home and utilising the same objective for the general population, those with disabilities and others with chronic or acute conditions, such as diabetes, asthma and other illnesses.
By accident or design, given the foregoing policies, the relatively large number of GPs in Ireland, compared with the small number of hospital beds and specialists, is of critical importance; more so, given the lack of the latter. Also, people want to stay at home rather than go to hospitals, psychiatric wards or nursing homes.
Under all these circumstances, it is an abomination that GPs are being cut back, with the likely effect of driving hundreds out of business. Even before these proposed cuts, there has been a significant fall in their numbers in recent years. If the cuts go ahead, the closure of GP surgeries will happen in poorer areas where GMS patient numbers are highest. Already, there is a shortage of GPs in poorer urban areas.
Poor people, who live at least five years less than those on the highest incomes – and who possess the highest incidence of all illnesses across the various socio-economic groups, according to the Institute of Public health – will suffer most. Those in most need will be hit hardest.
Rarely has any Government in Ireland introduced such a regressive and negatively far-reaching policy, which works in the opposite direction to what is desirable given all the available evidence.
Dr Tom O’Connor is a lecturer in economics and integrated care at Cork Institute of Technology. He is the editor of the book Integrated Care for Ireland (2013), Oak Tree Press