READERS' RESPONSE:Dr Mel Bates and Dr Mark Walsh respond to a Healthplusarticle on GP charges, March 2nd
HEALTH ISSUES are always prominent in the concerns and interests of the public, and the media play an important role in investigating, highlighting and reporting on all our behalf.
Recently there has been some comment on the perceived poor value for money relating to general practitioner services, particularly since the downturn in the economy and the expectation that costs to the patient should be universally less.
The GP/patient relationship is complex and in addressing issues such as value for money some thought or consideration should be given to the patient or consumer’s expectations.
To dwell on the concept of seeking a “quick fix” to an apparently simple problem will result in patients understandably feeling disappointed. However, if we stand back and reflect beyond just one isolated visit to the GP one can see that this perspective devalues the status of both the patient and the GP.
The relationship we as GPs enjoy with our patients is overwhelmingly positive. It is usually built up over many years through many varied encounters and is based on mutual trust and respect. This has been earned and fostered by both patient and doctor. Hard evidence for this is provided by the HSE’s Insight report of 2007 where GPs achieved the highest value and trust of all health professionals with satisfaction ratings in excess of 90 per cent.
A comprehensive, informed and up-to-date knowledge of health and illness is vitally important in the work of the GP which spans all aspects of medicine, health and social services and involves patients and their families of all ages. Patients present to their GP because they are worried they may have something serious or they don’t want to neglect their health or the health of their families.
They may have an acute episode of illness or they may attend for monitoring of a chronic illness, like high blood pressure or diabetes. Our experience of the same patient over many years helps us in trying to distinguish minor illness from serious illness. Seeing the same doctor on most occasions fosters a sense of trust and understanding and facilitates the sharing of diagnostic probabilities and an agreed management plan. We have added responsibilities in our role in referring patients to other services. Although referral to other specialist services is an option, approximately 90 per cent of all issues that present to GPs are dealt with by the GP or other community-based services.
The essence of general practice is the detailed, person-centred familiarity and knowledge we have of our patients as seen in the context of their families, communities and society at large. A number of core competencies can be identified and are often seamlessly utilised during consultations. We tend to take an overall holistic approach. Care is comprehensive and involves prevention, health promotion, support, advocacy, rehabilitation and palliation in addition to the traditional role in disease management. It is not unusual for a GP to care for individual members of a family through many shared experiences over many years.
This may involve care from antenatal care through infancy, childhood and adolescence to adulthood into old age for several family members, often simultaneously. Although each is cared for as an individual, their position on the balance between health and illness will impinge on the functioning of others and this influence must be recognised in the broader context of family medicine.
Also worthy of note is the fact that there is equity of access to GP services. There is no “two-tiered” system and access is not influenced by the ability or inability to pay directly for care. As a rule GPs have a real understanding for their patients who do not have a medical card and who have a reduced capacity to pay for whatever reason. It is not infrequent for the fee to be either reduced or waived in response to this need.
The question remains as to whether GP care constitutes good value for money. This is probably best viewed from a population perspective. There is strong evidence, based on robust international research, as to the economic arguments in favour of general practice. Starfield’s study in 1998 of 12 European countries and North America showed that countries with more highly developed systems of primary care (mainly GPs) was linked to lower costs and mortality rates, higher life expectancy and a greater satisfaction with their healthcare system.
GPs in Ireland deal with about 15 million consultations per year. In terms of the overall health budget this is value for money.
It is stated healthcare policy to put a greater emphasis on primary care in Ireland (“Primary Care, a New Direction”) and the transformation process is well under way. The management of chronic disease is placing an increasing burden on secondary care in our hospitals and much of this work could be achieved at less cost to the Exchequer in a primary care or community setting of which general practice is the key element.
GPs continue to be valued and viewed in high esteem at a personal level by their patients. There is much potential for the further development of general practice and hard evidence that this would be beneficial to society. It is timely to open debate and look at alternative methods of healthcare funding in Ireland.
Dr Mel Bates is chairman of Communications Committee of the Irish College of General Practitioners (ICGP) and Dr Mark Walsh is chairman of the council of the ICGP