GP service requires extra half a billion a year, HSE chief says

Report calls for substantial investment to move away from ‘hospital centric’ system

The health service requires an additional half a billion euro a year of transitional funding over 10 years to move to a properly functioning primary care GP based system, a report published on Monday says.

In a contribution to A Future Together: Building a Better GP and Primary Care Service, HSE director general Tony O’Brien says “we need a very substantial transitional investment... to move from the overly hospital centric system we now have”.

The report, commissioned by the HSE, was produced by researchers at the Department of Public Health and Primary Care at Trinity College Dublin, comes as the Government negotiates a new contract for GPs.

In his contribution to a plenary session, which along with an examination of international best practice and a large scale feedback exercise involving patients and healthcare professionals form the basis of the report, Mr O Brien adds: "we need to do things that go beyond, well beyond, the normal annual cycle and exploits to the greatest extent possible the fact that the current confidence and supply agreement commits to multi-year funding as opposed to single year funding, which doesn't provide an opportunity for real planning".


Significantly, the report finds that hospital consultants consider the reallocation of funds from hospital to general practice as a key development in addressing the problems in the health system.

Too many patients are unnecessarily funnelled into secondary care because of the weakness of primary care resources, with no direct access to diagnostic services such as scans or treatment from therapists and psychologists.

“This aggravates long waiting lists and queues in emergency departments,” the report notes.


The researchers found that Ireland has the lowest practice staff ratio of the countries studied. Countries that are rated highly on measures like access and services, have higher numbers of practice based staff, especially allied health professionals. In addition they estimate that 4.5 per cent of the entire health budget is spent on payments to GPs, which is the lowest proportion of the comparable countries looked at.

Dealing with hospital overcrowding the report notes that for urgent cases, GPs are forced to refer patients through the emergency department regardless of the condition. “GPs were often aware of the exact diagnosis but could not refer directly to the relevant department. The opinion of the consultants and the GPs was that this is contributing to hospital overcrowding,” it says.

Other key findings include:

– That 90 per cent of patients in the consumer studies were satisfied with their last GP visit. Access to appointments was highly rated. However 10 per cent of respondents commented unfavourably on the amount of time spent waiting in surgeries. The cost of seeing a GP deterred one in three patients;

– GP out of hours services provide more than a million consultations annually;

– Practice nurses were rated highly in the consumer surveys and considered to be central to delivering high quality care and ensuring continuity of care.


Senior Government sources said it wasn’t a surprise that Mr O’Brien was seeking additional funding for the health sector but acknowledged that transitional funding would be necessary to build up GP practice and reduce pressure on hospitals. Whatever that was, sources said, it was likely to fall short of Mr O’Brien’s requests.

A spokesperson for the Minister for Health Simon Harris said last night that the development of primary care is central to the Government’s healthcare plans and is in line with Slaintecare.

“The provision of a primary care fund in Budget 2018 demonstrates this commitment, as does the fact that the Ministers for Health and Finance have committed to multi-annual funding for primary care.

“Throughout 2018 there will also be a continued focus on the development of primary care centres and primary care teams.”

On the GP contract, the statement said, “the Minister would like to see agreement reached with GP representatives in the coming months on significant service developments that can be introduced during 2018. This will be the start of a multi-annual change process that will enhance the role of primary care as the foundation of a more accessible and effective health service.”

Muiris Houston

Dr Muiris Houston

Dr Muiris Houston is medical journalist, health analyst and Irish Times contributor

Pat Leahy

Pat Leahy

Pat Leahy is Political Editor of The Irish Times