THE NOW YEARLY release of GMS (general medical services) payment figures to GPs has put a spotlight on general practice and how it is funded this week. It is certainly the case that, in isolation and without context, the figures give the impression of a profitable profession.
However, within the context of the realities of the healthcare sector, these figures are very misleading. The figures released constitute the funding for the care of medical card and GP visit card patients along with other publicly funded patient services.
The National Association of General Practitioners (NAGP) criticised the release of individual GMS payment figures, stating that funding into general practice does not represent the take-home pay of GPs and could be misinterpreted. This funding covers care for all patients 24 hours a day, seven days a week, 365 days a year under the existing GMS contract.
A misleading impression
The release of these figures in isolation therefore provides a misleading impression that this is what GPs earn. GPs receive, on average, €9 per month for each medical card patient irrespective of whether they attend once or 10 times over that month. The reality is that these payments do not cover the cost of that care.
There is a direct correlation between the highest individual payments and areas of deprivation. The GPs in these areas have high numbers of public (GMS) patients. An example is Dr Austin O’Carroll, whose North Inner-City Dublin practice is composed of 95% medical card patients. Dr O’Carroll also runs 18 clinics in 7 locations for homeless people.
The figures given contribute to the cost of providing this service including the cost of premises, staff and insurance. Dr O’Carroll employs 9 GPs in addition to himself, along with support staff. The practice has had to employ extra doctors to serve extra clinics due to an increase in the number of homeless people accessing their services.
Only 3.5% of healthcare budget goes to GP services
In Ireland, only 3.5% of the healthcare budget goes to providing GP services. When we compare this internationally to countries who have well developed primary care systems, such as Australia, New Zealand, Denmark and Canada, we fall well behind that standard.
It has been shown that for every €1 spent on primary care, it saves €5 in secondary care. If, as proposed by the Slaintecare report, and as the government and HSE have stated, we are to make the decisive shift from secondary to primary care, then these services must be resourced.
FEMPI (Financial Emergency Measures in the Public Interest) cuts to general practice have taken place while business costs are rising and the number of medical card patients nears 50% of the population. The impact of these cuts is being felt by you, the patients, as pressure on GPs increase waiting times for an appointment.
We cannot look at funding in isolation
We must also look at what the GP is delivering in terms of care in the community. General Practice is operating under severe pressure as half of GP trainees are emigrating abroad in search of better terms and conditions. Our young GPs do not see general practice as viable. If the figures released represented the take-home pay for GPs, would we have this problem?
General Practice is the one section of the Health Service that is delivering for patients but it needs investment to allow GPs to provide a first-class standard of care to patients. This is what they are trained for and eager to deliver.
The day after these figures were released under FOI, the Minister for Health stated that he intends to extend free GP care to under 12s by the end of the year. We must, as a matter of urgency, address the capacity issues in general practice first. We must ensure that our most vulnerable patients – those with chronic diseases and the frail elderly are taken care of and have adequate, easily accessible, care in the community.
Resources must be considered before the introduction of additional cohorts of free patients. Otherwise, we will see the impact of the under 6’s free care multiplied and waiting times get even longer.
Chris Goodey is NAGP Chief Executive.
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