Spare a thought for our vanishing GPs, who keep so many of us out of hospital but get little in return

MY doctor called to see me at home on Saturday afternoon. This was unexpected because I thought that doctors only made house calls these days in cases of utter emergency and only after you’d begged them to do so.

I had seen him at his surgery only the day previously when he had given me a prescription for a chest infection that had inflamed my asthma and issued a firm warning that I needed to take to bed and some days off work.

The reason for his visit was that he wanted to check that the antibiotics were starting to work – as a batch of steroids I’d been given a week earlier hadn’t done the trick – and that I was following his instructions to rest (which I’m not necessarily the best at doing).

Even if I was slightly worried initially that he had felt it necessary to call – he had told me on Friday that if things got worse over the weekend I should consider a visit to the emergency department at St James’s – I was grateful to him for the reassurance he provided with a quick examination. And I was appreciative of the fact that he worried sufficiently about me, as one of his patients, to call in to see that I was recovering. By taking his advice – and resting – as well as the medication I’ll be back on radio today.

Understaffed

We rightly often laud nurses as the caring profession – and criticise hospital consultants for alleged aloofness (which, in the majority of my experiences, is unfair) – but we often forget the importance of the general practitioner in our health system and the fact that they, as professionals, care deeply too about the service they provide. Too often we hear complaints about the prices they charge, as if that was their only motivation, without acknowledging the costs of providing their services.

Unfortunately, we are running short of such doctors as our population increases and ages. As it happens, my GP had been hospitalised briefly the previous week because of the flu. His practice had to close for two days because he could not find a locum or a replacement who would run the surgery in his absence. On the Wednesday of the first week I visited, a replacement was present, although she too was coughing a lot and would probably have been better off in bed. But needs must. There was a lengthy queue of people who had to be helped because it is better that it be done there than in a busy hospital emergency department.

If things are bad in Dublin they are worse outside the main cities. Many GP practices are so understaffed that they are refusing to take new patients, even if they are willing to pay privately. Their workloads have gone up as successive governments have increased free healthcare, especially to the under-sixes (all of which is a good idea, as long as there are enough doctors to provide the services to the 1.3million medical card holders, now that 240,000 under-sixes qualify, irrespective of the income of their parents). The Government wants to extend free healthcare to an additional 500,000 people. But who will provide that service?

More and more doctors have retired or are nearing retirement age or have gone from the medical card system, opting to cater just for paying patients. The numbers coming into the system are dangerously low, with many newly qualified doctors opting for emigration, citing better pay and working conditions elsewhere. Some villages no longer have a doctor, as our reporter Michelle Fleming outlined in this paper recently in her chilling report from Bangor Erris in Co. Mayo, 40km west of Ballina about the impending loss of the local doctor. Others are living in fear of losing theirs.

Report

In counties like Wicklow you may have to wait ten days to see your doctor, which increases the chances you’ll either go to a busy ED at a hospital instead or allow your illness to worsen.

Nearly 3,000 doctors provide medical card services throughout the country but apparently when the HSE advertised looking for more doctors in many parts of the country they were unable to fill the vacancies.

The Irish College of General Practitioners estimated recently that Ireland has 64 GPs per 100,000 population, compared with between 90 and 100 in countries such as Canada, Scotland and England. Clearly, this is something of a crisis.

Yet at the same time, the Government has been well aware for years of the importance of resourcing the GP surgeries properly as a way of keeping people out of busy hospitals. GPs could, if provided with the resources – such as an ability to pay nurses and other support staff for increased output – offer care in the community for chronic conditions such as diabetes, chronic obstructive pulmonary disease and cardiovascular disease, administer injections to joints and treat minor ear, nose and throat conditions. They could even do X-rays, as well as doing blood samples as they already do, as long as the State pays for the equipment and operation of it.

The Sláintecare report – predictably gathering dust on shelves despite repeated claims that its all-party recommendations will be implemented – is based on reducing demands in our hospitals by offering extra GP services. The Government has budgeted for an additional 2,600 hospital beds over the next decade… if Sláintecare is implemented.

Battle

Without it, hospitals might need anywhere between 7,000 and 9,000 extra beds. That would require a massive investment, both in capital and current spending running into billions of euro.

Instead, the Government has engaged in a long-running battle with the doctors over existing contracts and new working arrangements that has all the signs of being millions wise but billions foolish.

As a response to the economic crisis just over a decade ago, the Government sought to reduce the money it spent on supporting GP services. In 2010, the Fianna Fáil-led government cut about €160million from GP services, which the doctors say resulted in an average 38% reduction in their State-provided income per patient. The Fine Gael-led Government has not restored the money.

It is now more than four years since Leo Varadkar, as the then Minister for Health, signed a memorandum of understanding with the Irish Medical Organisation to allow for the beginning of negotiations for a new GP contract. The negotiations got nowhere. New talks began in January.

The Government is understandably concerned about making excessive public sector pay commitments. There is no point in giving concessions on public spending only to have to take them back again. It is why the Government took a firm line on nurses’ pay.

What would an additional €500million annually on GP spending, both to improve pay and to increase services – a near doubling of what it costs already – do to reduce costs in the hospital system, or, more pertinently, reduce the amount of additional spending?

We may not get to the situation where everyone is lucky enough to have a doctor to call to the door, but we need to be able to see a doctor when necessary without having to go straight to hospital.

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