HSE’s masterclass on healthcare reform


Sir, – It is interesting that as its keynote speaker, the HSE picked an expert from the US, a country with one of the most expensive and worst-performing healthcare systems in the world (“Health cuts ‘wrong way’ to reform system, Harvard expert says”, Home News, May 16th) .

Prof Robert Kaplan tells us that GP’s shouldn’t be paid for simply “being there”, but for providing “excellent outcomes and efficient processes”, for which they would be rewarded. Clearly, he misconstrues “being there” in the sense that he is “there” in Harvard while delivering a masterclass to the “healthcare leaders” in the Irish health service, at a cost of €50,000 to the taxpayer. He further advocates a splintering of the GP’s clinical role into specific areas of focus – diabetes, disability, etc.

The key strength of Irish primary care is that the GP is in every sense “there” – 24 hours a day, 365 days a year. GPs provide around 25 million consultations annually, with a shrinking 3 per cent of the healthcare budget. They continue to deliver a high standard of care and provide value for money, in spite of being persistently undermined in this objective in both resourcing and policy terms.

Narrow goal-based incentives do work, as the British discovered where they resulted in an unanticipated £1.8 billion overspend in this area as targets were surpassed by GPs. But perhaps the HSE could start by allowing us to get on with even the basics.

As for Prof Kaplan’s issue with GPs dealing with “the whole range of conditions”, coming from the hyperspecialised world of US healthcare, he may well miss the whole point of general practice – to provide an integrated model of care where conditions are not compartmentalised and where the finer details can fall through the cracks as a patient moves between providers, none of whom are intimately acquainted with the patient’s needs in a holistic sense. – Yours, etc,


Riverside Medical Centre,


Dublin 15.