Free GP care for children


Sir, – Dr Mark Murphy’s opinion piece reflects many values and concerns that would be shared by his GP colleagues (“Doctors should welcome free GP care for children”, Opinion & Analysis, January 9th).

However, he has misinterpreted the O’Callaghan et al paper on GP workload for patients under six years by suggesting “that the under-sixes scheme increased the number of consultations from 2.8 per annum to 3.3”. The O’Callaghan paper was an audit of GP computer records and thus does not measure the patients who did not attend in the two years of the study, which has the effect of compressing the difference between the private and medical card patients’ attendance rates. Dr Murphy also fails to include the significant out-of-hours workload in his article.

If Dr Murphy had used the O’Callaghan increase in workload of 29 per cent, which is a similar increase in under-six visits to that being reported by some out-of-hours cooperatives and individual practices, and applied it to the estimated total population for the O’Callaghan study, he would have produced an increase in workload from 3.4 to 4.4 GP visits per annum in this population. Application of this plausible 29 per cent increase in workload to the 2019 Healthy Ireland figure of 2.3 visits per annum in the six- to 12-year-old age group, suggests universal free general practice will generate an average visit rate of three. Considering the national population of 500,000 in this demographic, the increase in visiting rates will result in a total increase in consultations that have to be served by GPs of 330,000. This is not a “small increase in consultation numbers”, as suggested by Dr Murphy.

What is missing from this debate is the annual extra GP in workload produced by the national population year-on-year increase of 60,000, of which 23,000 are aged over 64 years. This should produce a demand for an extra 270,000 GP face-to-face consultations based on the 2019 Healthy Ireland report.

Servicing of 600,000 GP consultations will take nearly 100 whole-time equivalent GPs. There will also be a demand for extra nurses and administrative staff. The GP training schemes are producing about 175 graduates annually. Two-thirds of these are women. Not all of them stay in Ireland or work in general practice full time. A significant proportion of the current GP population are close to or past retirement age. The younger GPs will not work the hours or provide the number of consultations that our retiring colleagues have historically delivered due to the increasing intensity of the career and a demand for work-life balance.

What will happen if the extra workload is dropped on general practice, which is currently working at full capacity, is that the older, sicker and poorer of the population who benefit most from continuity of care with a general practitioner will not be able to see their regular doctor when they need to. This will result in an exponential increase in hospital referrals and admissions. Is this good population-health management? – Yours, etc,



Dublin 12.

Sir, My colleague Dr Mark Murphy writes that, “Doctors should welcome free GP care for children”. He suggests that accessible care will follow the extension of free GP care to the under-12 age group. In his view, the main impediment to parents accessing care for their children is the cost.

No doubt this is true for a proportion of parents but accessibility is based on much more than ability to pay. GP services are accessible if there are enough GPs working in surgeries that are local to patients. They are accessible if they can provide appointments when the patient needs to be seen, not several days into the future. They are accessible because they continue to allow new patients to register in their surgeries. Based on experience with the under-sixes contract, people’s healthcare-seeking behaviour changes. They consult their doctor more, up 9.4 per cent in the daytime and 20.1 per cent in the out of hours, as per the same study mentioned by Dr Murphy. Any perception of reluctance on the part of GPs to extending services to the under-12s must be seen against the backdrop of capacity problems in general practice and experience with the under-sixes, both in and out of hours. – Yours, etc,


Dublin 3.

Sir, – Dr Mark Murphy does general practice a disservice in his article.

Many urban GPs and most rural GPs simply do not have the capacity or the resources to extend their service, beyond an already unsafe level. It’s simplistic to expect a shrinking GP population to absorb more work without massive recruitment and resources. Would Dr Murphy care to join me in a mixed urban and rural practice in west Connemara, with onerous out-of-hours duties, a 150km round trip from our nearest hospital, and an ambulance service hugely overstretched? It might help him understand some of the huge difficulties we face. – Yours, etc,


(GP for 45 years),


Co Galway.

Sir, – General practitioners in Ireland believe in and support universal equal access to all healthcare. There is dismay among GPs at the creeping privatisation of healthcare, including general practice, with little concern apparent on the part of our Government.

The terms “private patient” and “public patient” are repugnant.

GPs are acutely aware that no-one walks through their door without a reason. They do not regard medical complaints as “frivolous”.

Perhaps this year, or decade, will finally see the end of our obnoxious two-tier health system, which shames us all. – Yours, etc,


General Practitioner,


Co Wexford.