An overwhelmed general practice sector is bad for healthcare and for patients

Opinion: Minister should be prepared to think outside the box and engage with doctors

Under pressure: the average general practitioner in Ireland sees about 30 patients a day. Photograph: PA

Under pressure: the average general practitioner in Ireland sees about 30 patients a day. Photograph: PA

Fri, Nov 22, 2013, 00:01

General practitioners – or “family doctors” as the public know them – are interested in improving all areas of health. It is their job to improve the health of the very young as well as the elderly, to make life more liveable for the chronically ill, as well as to improve the wellbeing of the healthy.

It would seem logical, then, that GPs would support the introduction of free care for any group of their patients – especially the recent proposal to provide free care for children aged five and under.

Yet while doctors support the idea in principle they know that the current proposal will have a greater negative impact on some of their patients than it will have a positive effect on the children who currently don’t qualify for a medical card.

This is because they see the plan as a political gimmick and a money-saving exercise rather than a genuine attempt to provide a free GP service.

Primary care
Dr Reilly is fond of saying that we should have a “money follows the patient” system, but he seems to think this idea only works for hospitals and between hospitals. When patients move to primary care and have the bulk of their treatment from a GP, apparently he doesn’t believe that primary care should also receive the transfer of resources to facilitate this paradigm-changing move.

Over the last few years since the introduction of the FEMPI (Financial Emergency Measures in the Public Interest) legislation, GPs have had the income they receive from the HSE cut by as much as 33 per cent per patient. This is the income that provides for the GP surgery, heat, light, rent, equipment, staff and services.

Since the beginning of the recession there has been an increase in the numbers of patients on medical cards seeking treatment and an increase in the number of people with medical cards. These factors have increased workload while putting financial pressure on many practices.

Lose out
If the 280,000 or so children under six who currently don’t have a medical card are given one, then there will be a huge increase in visits to GPs and other patients will, of necessity, lose out.

The average GP in Ireland sees about 30 patients a day. This is not enough time to give each patient a proper consultation, and while many patients can be dealt with in a short space of time, others may require longer and more detailed consultations.

Research indicates that when a GP service is provided for free, people take advantage of that fact and visit their doctor about 2½ times more than they would if they had to pay for it.

What this means in terms of the under-sixes is that the 280,000 or so children who currently make about 1.3 million visits per year would, in all likelihood, make 2.8 million visits instead. It is impossible to believe that such an extra workload can be undertaken by doctors without more staff or more resources.

Survey after survey shows that most Irish people are happy with their GP service, a service that is provided with only 3 per cent of the health budget.

It could be argued that hospitals do more complicated and sophisticated work, but the GPs provide that essential service of keeping people out of hospitals by preventative measures. If the GP service is overwhelmed, it will have a serious follow-on impact on the rest of the health service with disastrous results.

The National Association of General Practitioners (NAGP) has been working to try to avert this potential crisis. Many GPs are now operating on a break-even basis. Some are looking at the possibility of emigration.

The solution is to move some resources (and eventually more patients) into primary care. The NAGP accepts that there is no more money available to be invested in healthcare – what we are suggesting is that proportionately more money from the overall health budget should go to general practice.

This will require courage and “thinking outside the box”. It will require an acceptance by the Minister (himself a GP) that general practice is a vital part of the health service, and one that must be properly resourced and maintained.

But mostly it will require a government that is willing to listen and communicate properly with family doctors about the vital role they perform and how it can best be safeguarded.

That can only happen if the Government begins to start taking its own doctrine of “money following the patient” seriously and stops using general practice as a method of cutting the overall health budget.

Lack of resources
We have to start investing in the future of general practice, and that future will mean more and more pressure on the service. It will mean a better service overall, it will reduce cost in the long run, but it cannot be done without facing up to the lack of resources that currently prevails in general practice.

Protecting the future of our health service means, in the first instance, protecting the frontline of medicine and enhancing it. From our perspective in the NAGP, we are ready and willing to play a role in making the GP service better, but we cannot do that while money is poured into secondary care, while primary care is starved of resources.


Chris Goodey is CEO of the National Association of General Practitioners, which holds its annual conference in Dublin this weekend

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