Free GP care for under-6s will require ‘far more GPs’

Draft contract for provision of free care for under-6s not deliverable, conference hears

Implementing health reforms such as free GP care for children under-6 will require “far more GPs and practice nurses” and providing an environment for doctors to do the job they were trained to do, a GPs conference heard at the weekend.

Minister of State for Primary Care Alex White was heckled as he spoke in Clonmel on Saturday about the draft contract for GPs to deliver under-6 care but said he will engage with GPs before any policies are finalised.

The Irish College of General Practitioners has described the Government’s new draft contract for the provision of free GP care for the under-6s as “not deliverable with current available manpower ” and the college’s medical director said the contract is a forerunner for the whole population.

“It’s all-encompassing, it’s vague, it’s bureaucratic. It’s layers and layers of things that will have to be reported on,” said Dr Margaret O’Riordan.


“ If you’re going to have your GP spending time reporting and doing paperwork then they’re not delivering the services they were trained to deliver.”

Resources in general practice have been cut by up to 38 per cent in recent years, the conference heard, with Dr O’Riordan describing the situation as “an ongoing saga of crisis for general practice”. The Government’s contract doesn’t take into account the reality of the current resources in general practice, she said. “If it [the new contract] was to be delivered it will require far more GPs and practice nurses.”

Addressing the conference, Mr White accepted there is “an issue with resources” and said he could see the impact that health cuts have had. “But when I go back and talk in Dublin to colleagues in government about primary care and the manifest need for more resources in primary care, I’ve got to actually also talk to them and argue with them about how we can together reconfigure primary care. And primary care is about more than general practice, although general practice is at the very heart of it, and the indispensable heart of it.”

Primary care is more than the doctor, the practice nurse and the receptionist, Mr White said. “It isn’t just going to be a question of giving more resources, although I accept that you have to have those resources, and I accept that primary care is under-resourced and I accept, as anyone with a brain can see, that in a country where you’ve had the kind of economic collapse that we’ve had, the impact that it’s had on social services.

“You cannot take €3 billion out of the health service and say it’s not going to have an impact, it’s clearly had a serious impact and it’s visible to me right across the country and it’s visible to me and manifest to me that that has to be addressed. But we can only do this in a process with dialogue.”

There was some heckling from the floor from ICGP members when he mentioned the under-6 contract and said: “It’s not just about me handing you a contract and saying, ‘sign it, take it or leave it’. That is not my intention.”

He denied the contract was a “fait accompli” and said the Government will be discussing the draft contract with representative bodies.

Professor Jim Lucey, medical director of St Patrick's Mental Health Services in Dublin, urged GPs to embrace primary care but pointed out that change cannot happen without them. "The people you're in a scrap with know they cannot deliver either the service or the reform of the service without you."