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'In a utopian society there would be free GP care. In reality, we can't do that'

Doctors are struggling with a jump in consultations and lack of resources.

Image: Shutterstock/Andrei_R

FREE GP CARE is something to aspire to, but not easy to make a success.

Doctors have long warned that the plan to roll out universal free GP care wouldn’t work unless more money and resources were put into General Practice.

Since free GP care for under 6s was introduced in 2015, there has been an increase in the number of consultations at many practices. Some out-of-hours GP services have seen consultations jumped by 40% in the last year, something at least partially down to the new measure.

This scenario was somewhat inevitable and forewarned by the National Association of General Practitioners (NAGP), among others.

NAGP President Dr Emmet Kerin, who runs a GP practice in Limerick, said Ireland simply doesn’t have the capacity to bring in free universal GP care in the next five years as planned.

Last month the Irish Medical Organisation’s outgoing president Dr John Duddy said the proposal is not practical unless it’s properly costed.

Kerin agrees with this, telling TheJournal.ie: “We certainly don’t have the capacity for it. In a utopian society there would be free point-of-care access. In reality, we don’t have the capacity to handle the increased consultations. The NAGP signalled this before it was rolled out for under 6s.”

Kerin says the fact more parents are bringing their children to their GP is “displacing other patients, particularly the elderly and frail”, many of whom go to their local emergency department when they can’t get a same-day appointment at their GP, further exacerbating overcrowding there.

“All societies that have universal free point of care access struggle with capacity,” Kerin says, using the NHS in the UK as an example.

It keeps building and escalating. I don’t for one minute object to a parent looking for assurance that their child is well. Open-end free access will be very heavily used and we don’t have the funding and manpower to back that up, certainly not within five years.

“You can’t land everything on top of general practice overnight,” Kerin notes, but says “massive strides” could be made in terms of the services provided by general practice and primary care if the necessary funding and resources are made available.

Kerin says the health service may be better off prioritising issues other than free GP care, such as “giving medical care to those in need instead of age cohorts” and tackling the “massive problem” the country has in terms of diabetes and obesity, adding that we should be moving in the direction of preventative medicine.

Free GP is one of several issues due to be discussed at the NAGP’s annual general meeting, which is taking place in Maynooth, Co Kildare today and tomorrow. The organisation has 1,900 members nationwide.

Emigration

“General practice is very much still in crisis,” Kerin says, citing the number of doctors who emigrate and the ongoing impact of pay cuts brought in under the Financial Emergency Measures in the Public Interest (FEMPI) Act.

The Irish College of General Practitioners (ICGP) was unable to fill its training scheme quota this year, for the first time ever.

Kerin says he understands why young doctors choose to leave Ireland. He believes an uncertain future and working conditions play a bigger role in making that decision than monetary reasons, but acknowledges doctors can earn more abroad.

Younger GPs look at older GPs – they’re thin and stressed over work, and they make a lifestyle choice.

Doctors train for several years and many have families here so don’t want to move, but need job security, he adds.

“When FEMPI came in practices had to let people go over night, many can’t afford to take on another GP,” Kerin says.

“If you unwind FEMPI you will restore confidence back into the service.”

Negotiations on a new General Medical Services contract are ongoing, with Kerin saying he hopes the NAGP, IMO, Department of Health and HSE can all sit down in the same room to discuss this soon. Currently the two medical organisations are holding separate negotiations.

Kerin describes the current progress as “glacial, very slow”. This process may sped up when the Oireachtas Committee on the Future of Healthcare publishes its 10-year plan.

Speaking of the committee’s work, Kerin says: “I hope it does what it says on tin, takes politics out of health.

“If [the report] is based on evidence and best practice, I’ll go with it. If it’s a politician on solo run trying to get an agenda through, I won’t.”

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