Solution to A&E crisis in hospitals, say family doctors

GPs' agm in Galway: General practitioners have rejected a suggestion that they have contributed to the crisis in hospital accident…

GPs' agm in Galway: General practitioners have rejected a suggestion that they have contributed to the crisis in hospital accident and emergency departments.

The solution to the A&E problem is primarily in the hospital sector, the organisation representing family doctors in the Republic has said.

Doctors at the annual meeting of the Irish College of General Practitioners (ICGP) in Galway yesterday unanimously passed a motion calling on the Health Service Executive (HSE), the Department of Health and Minister for Health Mary Harney to recognise the accident and emergency crisis as a "complex health system problem and that the solution must be found primarily in hospitals, in their efficiency and bed capacity, and not in general practice".

Proposing the motion, Dr Annraoi Finnegan, a GP in Ballinasloe, Co Galway, said that less than 1 per cent of patients seen by GPs every day are referred to hospital A&E departments. "It is hard to accept that general practice is part of the problem [in A&E].

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The current system is patently not working. There is a bottleneck with not enough beds available for patients."

Dr Illona Duffy, a GP in Monaghan, said the only way to solve the A&E problem was to increase the number of beds in the hospital sector.

Meanwhile, family doctors and their patients should be wary of the "corporatisation" of general practice here, the meeting was told.

Dr Simon Morgan of the Royal Australian College of General Practitioners told doctors that the prime motive for companies in Australia, who have purchased the goodwill of practices, has been to increase profitability.

Some 8 per cent of GPs in Australia are now employees of companies and this has led to concerns about standards in such practices and consumer choice, he said.

"The chief concern has been the potential for breaching the primacy of the GP-patient relationship. The corporate model erodes the sensitivity of this relationship," said Dr Morgan.

Describing the potential damage to the continuity of patient care of doctors becoming company employees, Dr Morgan added: "With Irish general practice on the cusp of greater corporatisation, the ethical issues, potential power imbalance and conflicts of interest inherent in the corporatised model of general practice must be addressed by the profession, Government and the consumers of health services."

Speaking of the ICGP's vision for general practice under a new contract its chairman, Dr Éamonn Shanahan said there was a need for greater investment in general practice premises by both the State and private insurance companies.

"There is a particular need for this in areas of deprivation, such as the inner cities," he noted.

Emphasising the high satisfaction rates expressed by patients here about their access to a specific family doctor, he said the college would support incentives for GPs wishing to join practices of five partners or less. But he said GPs were against the notion of primary care "super teams" which were unwieldy and would waste valuable clinical time satisfying the needs of bureaucracy.

Presenting the results of the latest survey of general practice in the Republic, Prof Tom O'Dowd of the Department of Public Health and Primary Care said there had been a significant increase in the number of three- doctor practices in the last 13 years, with a drop of one-third in the number of single-handed GPs.

"There has been a big increase in attached staff such as nursing, clerical and management personnel since 1992" he said.

"General practice has demonstrated achievement even when public policy has overlooked its potential to make a difference to the health of the people of Ireland."