NEITHER THE NATIONAL Medical Card Unit (NMCU) nor the HSE collate or count the number of applications from people who have been unable to obtain a GP appointment in their locality.
If a person is unable to secure a doctor’s appointment in their area, the rules set out that they can get in touch with the medical card unit indicating that they have applied to three practices who were unable to accept them on their panels.
In such circumstances, the client can then be assigned to an available GP who has a contract with the HSE.
The Dáil has heard that 70% of GPs have closed their lists to new patients as it is the only way they can control their workloads.
Despite a government deal to improve conditions for doctors, the number of GPs has been static since the start of the year.
The HSE said they are aware of the situation of doctors closing their lists, which is resulting in some people being unable to book a doctor’s appointment or even be added the clinic’s list of patients.
Speaking to TheJournal.ie, one person said they had moved to a new county the previous year. When they needed to book a doctor’s appointment they called their local primary care centre.
However, they were told due to the increase in population in the area, there were not enough GPs to cover demand. As they were not “a local”, they could not be added to the list.
They were also informed that this was a national issue, and not just a local problem. This person was forced to travel back to their home county to visit their family doctor.
The HSE said in a statement that GP panels are frozen for primarily two reasons. When there is a resignation or retirement of a doctor, the panel remains frozen for a period of three months from the time a new one is appointed.
Patients cannot move from frozen panels but new patients can be added.
The other reason is when panels exceed the number of patients they are allowed care for.
GP contract
Under the GP contract, the total number of patients placed on a panel cannot exceed 2,000. This figure increases to 2,200 under the under six age group contract. Should a doctor exceed this limit, a freeze on the panel is introduced.
No new patients can be added to the panel until the time the numbers decrease.
The HSE says that any medical card holder who is facing difficulty obtaining a GP is advised to correspond directly with the NMCU.
“If there are specific cases concerning GP assignments of access to local practices, the HSE would welcome the details on such cases to ensure that any feedback and learning can be taken into our reviewing our processes and service,” the HSE said in a statement.
When asked how many applications the NMCU has received from people unable to get on panels, the HSE stated:
In respect of the number of applications made to the National Medical Card Unit in relation to people not being able to see a GP in their area in the last year, the HSE/NMCU do not routinely collate this information.
Sinn Féin’s Louise O’Reilly said “the analysis of most GPs is that General Practice is under huge strain due to funding difficulties and a shortage of GPs”.
“This means that GPs are under huge pressure and the result for patients is that many GP patient lists are full, or a GP appointment will take almost a week to schedule, and sometimes more than that.”
She added:
We believe directly employed HSE GPs have a role to play in alleviating this capacity crisis and providing care in areas that are experiencing difficulties.
In order to get further information on how many people might be experiencing difficulties in seeing a doctor in their area, TheJournal.ie contacted all community healthcare organisations to ask if their panels were open or closed to new patients.
Below each community health organisation is listed, with details of what doctors’ lists are open or frozen.
Louth / Meath area
A spokesperson for CHO Area 8 said the Louth/ Meath area has never “closed” a list, but said on occasions there has been a temporary “freeze” of a panel.
“Upon retirement or resignation we will endeavour to find a GP from within the practice or the surrounding area to oversee the vacant list in a temporary/locum capacity until we recruit permanently, which we always strive to do as quickly as possible.
“While the panel is being held in a locum capacity it will be ‘frozen’ to ensure the list does not diminish and is still attractive, enticing a new GP to apply for the permanent role.
“A frozen panel means that there is minimum movement, but once the panel is not full (2,000 patients on a GMS contract or 2,200 if the GP holds GMS and Under six age group contract — and most GPs do) the Primary Care Reimbursement Service (PCRS) still has access and permission to assign patients to the list,” they said.
The spokesperson added that where there have been no resignations or movement of doctors, the PCRS will automatically freeze a panel that reaches the maximum allowed.
“In exceptional circumstances we can override this at the request of the GP where they say they have capacity for more patients. This is very rare, but has happened in areas where large numbers of private patients have a change in circumstance and are issued Medical Cards,” they said.
“It would be rare for a CHO to freeze a panel with exception of the GP meeting maximum capacity or leaving the post, although they added that some GPs freeze their panels even before the 2,200 limit if they feel the number of patients exceeds the capacity of the practice,” they said.
They noted that practices also have to contend with their private patients, which can be significant. The spokesperson added that the practices don’t always inform the HSE when they freeze their panels to new patients, but they deal directly with PCRS.
As of the end of the summer, there were nine panels frozen in the Louth/Meath area.
The other seven panels were also advised that a decision will have to be made with regard to the long term.
On average, the Louth/Meath area has one request per week from people who cannot get on to a panel, with occasional weeks having more.
The Midlands
In the Midlands area, the standard practice is that panels are frozen for a specified period in the case of resignation/retirement/death of a doctor.
The panels are frozen up to six months prior to a GP’s retirement/resignation and up to a period of three months after a permanent person appointed.
In 2019, there were 11 panels frozen in the Midlands area due to resignations/retirements during the year.
Out of this total, as of the end of the August, five of these panels were frozen.
A spokesperson stated that panels are automatically frozen when they reach 2,200 patients which is the maximum permitted limit.
Dublin North City and County
As of the end of August, one GP panel was frozen and maintained in a locum capacity until a permanent GP was appointed.
This panel was frozen “due to exceeding the limitation of numbers”, which as stated above, is 2,200 since the under 6s contract was implemented.
A spokesperson for community healthcare organisation Area 9 said GPs manage their own practices and determine how many patients they can manage to care for on their GMS panels.
“Therefore, GPs make their own decision to close off panels when they reach a certain limit particularly the single-handed GP whereby they may not be in a position to manage a large panel of GMS patients particularly if they have a large private practice also.
“The PCU would not have access to any of the details in this regard particularly the number of GPs who have closed off their panels.”
Carlow, Kilkenny, South Tipperary, Waterford and Wexford
In the South East Community Healthcare area, which delivers Primary Care services in counties Carlow, Kilkenny, South Tipperary, Waterford and Wexford, six GP panels were ‘frozen’ as of the end of August.
In this region there are no GPs whose panel is frozen due to exceeding the limitation of numbers, said a spokesperson.
They added that GPs make their own decision to close off panels. Like other regional organisations, the data on the number of applications made by people who could not get to see a doctor is not held locally.
As stated previously, the HSE states that it also does not collate this information.
Cavan, Donegal, Leitrim, Monaghan, and Sligo
A spokesperson for this community healthcare organisation area stated that occasionally panels are frozen, meaning patients cannot transfer off the panel to another GP for a period of time about three to six months.
They said people can continue to register with a panel even if it is frozen.
As of the end of August, there were six frozen panels across CHO Area 1 , three of which are locum panels. Again, they added that the local office does not hold records for persons from its area who have made applications in relation to getting on a GP list.
Limerick, Clare, North Tipperary
According to a spokesperson for the region, there are no GPs whose panels are frozen due to exceeding the limitation of numbers.
Galway, Mayo and Roscommon Community Healthcare West said it was not in a position to state how many GP panels have been closed in Galway, Mayo and Roscommon in the last year.
It also said it is not in a position to state how many applications were made to the National Medical Card Unit from its locality in the last year in relation to getting on a GP list.
Dublin South, Kildare & West Wicklow
There are currently six panels in Dublin South, Kildare and West Wicklow that have a freeze in place.
The local organisation said it was not in a position to state how many applications were made to the National Medical Card Unit from the region in the last year in relation to getting on a GP list.
TheJournal.ie did not receive a response with information for Dublin South East, Dun Laoghaire, Wicklow (CHO Area 6), and Cork and Kerry (CHO Area 4).
Health Minister Simon Harris has said this investment will mean significant increases in capitation fees for GPs who participate in the reform programme, as well as the introduction of new fees and subsidies for additional services.
There will also be increased support for rural practices and for those in disadvantaged urban areas. There will also be a ring-fenced fund for general practice in urban areas.
Last month, doctors said the government’s plan to extend free GP care to children under the age of eight will lead to mounting pressure on a service already near breaking point in many areas.
The government confirmed that the extension of free GP care, which is already available to children under the age of six, was included in Budget 2020.
The move was criticised by the Irish Medical Organisation (IMO), a body that represents doctors across the country, which said it had not agreed to its implementation.
Denis McCauley, Chairman of the IMO GP Committee, said doctors’ concerns stem from capacity and infrastructure issues.
“When you give somebody a medical card, it’s a fact that they will attend the doctor more regularly. That’s not a judgement, it’s just a fact,” McCauley said.
He said patients throughout the country are dealing with the impact of the government’s decision to bring in free GP care for certain age groups.
“Patients see the impact of this on the ground because they cannot get onto a local doctor’s list, they have closed their list due to capacity issues.
Even when patients are members of a practice, they sometimes have to wait several days if not weeks to see a GP. There is severe pressure on capacity in general practice.
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