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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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As a Spanish I had never paid to see a doctor or even a consultant until I came to Ireland 20 years ago. And I very rarely had to queue for more than 20 minutes either. So other countries manage to give free health care to all their citizens, regardless of their income. Why not Ireland?
@Angeles: doesn’t Spain have triple our unemployment rate? Lovely country and people, not sure I’d copy their economic model.
@Geoff Lillis: he’s not referring to their economic model. He’s referring to their health system! Why do the Irish get so bloody defensive anytime an “outsider” dare criticise the country.
@Angeles: 1.05 euro to see your GP in Bulgaria. State subsidised. No charge to visit A&E, no waiting to be seen, no trollies.
Poorest country in Europe.
@Angeles: That is because employers pay a large social security payment on your behalf. Minimum amount is about 300 EUR per month, even if the employee is only part time. So the part timer working say 20 hours per month earning 200 EUR per month, costs the employer 500…so 25 EUR per hour for a cleaner. Or even the business owner who does not actually work in the business has to pay the 300 EUR for themselves…for each business they own. So if Ireland wants the same free GP let’s see what it will do to business and employment. The reason the Irish economy recovered from the crisis is because we have a solid underlying economy…Spain on the other hand won’t recover any time soon with it’s anti business laws.
@Mary Murphy: Australia has a strong economy and free GP and hospital care. So, not sure your point is valid.
Would we not all agree that it would be nice, but doesn’t fit in our current economic model
It’s quite simple really, we don’t have a big surplus to play with to fund it straight away.
If we want it, we’ll have to adjust our model. Which means pushing something else to make it work.
And there’s the question… (rather than just saying “but they do it so why don’t we”)
@Anita R: Do employers pay 300 EUR every month in social contributions even when you only work 20 hours per month. Additionally Australia has a economy held up by mining. Manufacturing has collapsed, so when China stops wanting the stuff Australia has in the ground they have to go to plan B which is sell land to Chinese. Spain is trying this now and raised 2.16bn is golden visas last year.
@Mary Murphy: Ireland hasn’t recovered –
Health And other Services in tatters
Rising Homelessness
Rising Poverty
High number of low paid jobs
Debt in excess of 200billion and rising
@Mary Murphy: A person’s state of health in this cesspool is considered a commodity. A commodity for profit. Your state of health depends on the state of your bank balance.
Such is neoliberalism.
People don’t pay in the UK to see a GP. BUT, they have a long waiting list and might have to wait days, while in Ireland you can just walk in. Also, in the UK you get much less time with a GP, in and out in no time at all.
@Anita R: I wouldn’t use Australia has a good example of a strong economy. As someone who is currently working here and in mining, it has deep structural flaws that are worse than Ireland’s in many ways.
@Dave Doyle: I read my comments several times, can’t see where I mentioned anything about bank balance. I am simply making the point that if we want a better health service we have to pay for it collectively. Spain has a better health service and the main difference is that employers pay for it on behalf of employees. If we want the same model in Ireland it will have an effect of an employers ability to hire staff. Actually if anything the comment I am making is if we as a nation want a better health service we have to lower our own personal bank balances and pay for it
We are going the American way. GP access and healthcare if you can afford it.
If not, take your chances in A&E.
@Tony Daly, hardly, with a third of people on medical cards.
@Tony Daly: drama queen. The real poor are the middle class
@cholly appleseed: it’s those on medical that are alright .. they get the free health care and dental care . Middle class / low income are being screwed over . They can’t even afford a consultation never mind dental treatment. . .
@Tony Daly: it’s €100 in a&e unless you go to gp first
@Gulliver Foyle: Not if you have a medical card
@Tony Daly: A trip to the GP costs around €60. To A&E it’s €100. At least that’s what it cost me recently.
My daughter had a free GP visits for u6s and thankfully never had call to use it!
If we can’t afford to give it to all, would it not be more sensible to give free GP care to all children with chronic illnesses rather than all children under a certain age or maybe to give all children 3 free visits a year only!
@Niamh Ní Comhraidhe: How about free visits for anyone who has paid in – or their parents have paid in, if a child ?
Anyone else – tough.
€60 to see a doctor is disgraceful.
@Mocky: it costs more for a plumber
@Chef Harold: A plumber cant see 10 patients/customers an hour.
@Chef Harold: It also costs more than anywhere else in the world. Not to mention what value you get for that money.
@Paul P O’Sullivan: 10 patients an hour! You really are deluded
@Clare Maurer: he’s not deluded Clare, I had an appointment two weeks ago in a rural practice and was waiting for over an hour as there were at least nine or ten people before me and as many came after me. Bloods taken and a prescription written, 5 mins top and was charged 50 euro for the privilege.
@molly coddled: do you think that’s all that was done? you rock up, give bloods and eff off again?
those bloods have to transported to a lab,
then they have to be analysed by an expert who then has to see if there are grounds to flag any illness in the patient
then they have to fill out the paperwork
they have to contact the GP back with the results.
GP has to follow up with you also
All of this takes time and effort from people working in our health service.
when you pay 3.50 for a box of weetabix, you plainly dont consider the effort made to plant seed, tend and grow the produce and then harvest it, transport it to a plant, process it, box it and transport it to the shop for you to begrudgingly pay for!!!
@Chef Harold: Not sure a plumber, no matter how qualified could treat my arthritis!
Had to wait two weeks for a doc as I had no money – and I work for a living.
Scrotes refusing to work “until it pays what they feel they worth” (direct AAA/PBP quote there) can turn up whenever they want.
Shocking system.
@Ros Aodha: excuse me, I know exactly what it entails as these costs are incorporated into the 50 euro, but I most certainly do not expect to be kept waiting for over an hour after making an appointment without any apology for delay. Clearly this practice (which I may add am going to change from, as I have the right as a fee paying customer) overbooked to maximise profit.
@Mocky: free to see a doctor in Portugal. INR blood test 80 cents. Medication much cheaper too.
@molly coddled: Wow, what an ill informed comment. How do you know that there wasn’t a serious cardiac arrest in the time before you came in that caused a backlog on the rest of the day? How do you know that some patient who came in for routine bloods didn’t break down as they are having difficulties at home and your GP did the right thing and discussed the difficulties in their life.
I’ll hold my hands up here, I’m a recently qualified doctor. However, I definitely didn’t do medicine for the money, I left a high paying finance job to put myself in considerable debt to become a doctor. I slogged the last 4 years when all my mates were out partying, going on holidays, progressing in their careers. And the reason I did it? To help people. As did the vast majority of people in my graduate entry medicine class. We all left decent jobs in order to go back and help people. And I have no regrets in the world about it. However, I’m disheartened by comments such as the above that implies that GP’s are in the business of maximising profits. Some GPs are barely breaking even now. Which is why there is going to be a significant shortage of rural GPs in the coming years. Funding from the HSE has been cut, base line costs have gone up. For your 50 euro, this contributes to the GPs costs which could include a receptionist, a nurse, a physio, an IT software system etc. And most importantly, it could help to pay the GPs insurance which in some cases can be 10′s of thousands.
@molly coddled: you are exactly the type of patient/person that anyone working in the health sector loathes.
No appreciation for the fact that people are working as hard as they can.
Did it ever occur to you that when a gp opens the practice there could be 5-6 patients with no appointments waiting at the door?
What should they do in this case ? Turn them away so you can be seen on time is it?
God forbid you should ever need an emergency appointment at a gp and keep someone else waiting.
Word of advice, I’d say your gp will be glad to see the back of you.
@Theunpopularpopulist: I’ve never in my life ever seen a queue outside a doctor’s surgery.
Lots of European countries have free GP care. In fact, these are the same countries that have no waiting lists in hospitals and a wider range of options available to patients. In my opinion the issue is with mindset!
What sort of society do irish people want to live in?
The one where apple inc don’t need to pay 13 billion in tax and sick neighbours can fxxk off and die cause they can’t pony up?
Is it free or is the GP getting paid by the State/Taxpayer for under 6 consultations? If the are so paid for, is it less profitable than getting paid directly by an over 6 patient?
Are GPs saying these kids actually don’t need to be seen and these are frivolous visits?
@alphanautica: If I remember correctly, it works like the medical card patients and the GPs get paid per patient per year no matter how many times the patient comes. I don’t know the amounts but I think if a medical card holder goes to the GP more than once a year they are already losing money compared to normal consultation prices.
@Jenny mcCarty: Working parents only bring kids to gp when absolutely necessary because they need to justify the day off work.
@Sandra Turner: yeah your absolutely right! If your child has a sniffle a creche wont take them, need to get your child seen to as quick as possible so you don’t miss more days due to minding a sick child
@alphanautica: yes !
@Clare Maurer: Don’t know what kind of creches you work with. I think I’ve used my sons free gp card once and that was for a chest infection with an out of hours doctor on a Saturday because my gp surgery only opens 9-5 Monday to Friday.
I would be glad if the GP visit was €20! My GP just upped his price to €60 per visit. I have to hope I don’t get sick at the end of the month.
@Deborah Behan: Laya healthcare do a CareOnCall app, video consultation with a doctor, faxes prescriptions to your choice of pharmacy. Something like €23 a go for non customers I think. Might work for you.
@Geoff Lillis: VHI have Nurse on Call and it’s better than nothing but not the same as a GP, IMHO.
Seem to be able to do it the UK?
@Stouts O Shea: in the UK you can be waiting over 2 weeks for a GP visit because if you don’t have to pay it will be abused – as with any system
This seems more like a negotiation stance for medical professionals putting one section of society against another in order to get a good deal from government. If you want a strong economy and workforce you need a good health care system. This should be a bit easier in a neutral country with lower military costs. New Zealand (similar size) seems to do alright…
@BoggerBlogger: 1. Ireland is not and never has been a neutral country, we neither ratified nor signed the hague nor geneva conventions. we have a foreign policy of non involvement on a case by case basis under the triple lock agreement. you wont find mention of the word neutral in the constitution either.
2. You equate lower military spending with higher health expenditure? Dont make me laugh. a completely unfounded and idiotic statement.
you DO realise that we spend ~800 million on national defence right?
you DO know that the health budget is about 14 BILLION annually?
you also know that we spend almost as much on overseas AID as we do on national defence right? around 600 millions euros GIVEN AWAY to other countries?
That paltry tiny 800 million (second lowest defence spend in EU by the way) funds
22 aircraft,
~ 2000 other vehicles cars, vans, trucks, armoured vehicles, recovery vehicles, maintenance vehicles, naval and air corps vehicles, fire engines, ambulances, etc)
8 naval vessels
All the weapons that the defence forces have
Munitions,
Fuel,
Spare parts,
Maintenance on all of the above
9500 personnel,
a handful of barracks (that havent yet been sold off)
The money it costs to move and transport and deploy all of the above
pays for the REMAINING barracks around the country
Food,
Light,
Heating,
Water
Uniforms,
The list is endless if i’m honest
And with that spattering of equipment they strive to secure this country, the overseas missions they’re on and one of the largest maritime domains in the entire EU with one of the smallest navy’s? All of this is done in a very efficient and value for money manner.
Now tell me how the dept of health is run in such a fiscally tight and accountable manner?
Only thing we underfund in ireland IS the military, lowest paid element of the public sector. Best return on our investment. Also if we truly want to be a sovereign neutral state, we had damned well better shell out to equip our military to be in a state that they can ENFORCE and DEFEND that neutrality. if you want to see how a neutral state works, I suggest you look closer to home, the EU, Austria, Switzerland, Sweden, Finland. All field credible naval defences, credible (currently non existent) air detection (no primary or secondary military radar to watch the atlantic) air intercept (non existent) and air defences, both land and air based and a hard land defence component. with our current budget, we cant possible hope to do this. we should increase military spending towards 2% GDP from its current 0.5%
@Ros Aodha: Lot of info there. Okay:
1. Fair point, just using neutral for shorthand but effectively neutral
2. No, you equated lower military spending with higher health expenditure. I just mentioned that we have very low military expenditure – whereas you explained in great detail that we have very low military expenditure. Is there an echo in here?
@Ros Aodha: and the RAF will protect our airspace, that the government for you and civil service, 20 billion on social wellfare 300 million are year on over seas aid, sure where a great people!!
DEFINE FREE?????
@Dan Mc: someone else is paying
@lavbeer: thought so. Hopefully, in a utopian society media outlets would be responsible enough to define the term “free” before writing this trollop.
@lavbeer: *Everyone is paying
@Sean Claffey: everyone is not paying. A lot of people with medical cards are net beneficiaries not net contributors to the state.
@Theunpopularpopulist: they MAY currently be “net beneficiaries”, though it’s hard to say because you would need to include things like how many roads they drive on, if they drive at all – if not, that is one less thing they are benefiting from – and how much police manpower has been spent on criminals likely to target them and so on. People often tend to only include costs like healthcare and social welfare, when there are many others too and it’s hard to say how much any of us is benefiting.
But for the sake of argument, let’s say they are currently net benificiaries. Long-term unemployment is a year or more. Most people are unemployed for less than that. So let’s say they have been net benificiaries for the past 10 months. They may have been net contributors for the previous 20 years. So should they not now get some of that back?
Could be any of us this time next month. All it would take is a serious car accident, say, that left us permanently disabled and in need of long-term medical care. You aren’t talking about any one group of people, but rather, a group most of us WILL be in at some point since most over 70s have a medical card.
I would hardly call England utopia but it still manages to give free health care. Cuba has free health care and they were classed as a underdeveloped country. It’s frankly embarrassing that Ireland doesn’t have free health care for all.
Utopia = free GP care!? Please ..a fair equitable health service that provides access based on need is not Utopia but it will need vision, nerves of steel, a refocus of existing & more resources, & challenging vested interests to give us a single tier health system & accountability from all concerned including the private health sector & insurance companies… thinking we can’t afford it is part of the problem
I don’t get this #NotEnoughMoney nonsense. Ireland has plenty of money. It decides to waste it – evoting machines, a children’s hospital that still has to break ground to name two but there are loads. Stop mismanaging the funds and start looking after its citizens.
@Lynne Tunney: I agree Lynne. What about all the medical care and free housing and stuff for the many thousands of refugees and economic migrants? Will they not give us that free stuff too?
@Grainne Abdulaziz: Take your racism and xenophobia, and shove it where the sun doesn’t shine
cut the medical card, the under sixes was a disaster as mothers are running down for every little spot on there darlings, people who work not only pay for this but have to bear the cost of a GP 55 up to 65 euros, at the same time they are subsidising medical card holder who in some cases get it because they cant read i kid you not, and then the junkies who have free travel and medical care, nothing will change till everyone is pay their fare share!
Not with fine gael or fianna fail policies can this be acheived they leed us to present health mess
@Grainne Abdulaziz: Perhaps your hero, the Egyptian saint Halawa could train as a GP ?
After trying to blow the s**t out of civilisation of course.
Orla is typical of many Irish people who have been brain washed to think that health care, especially primary care is a luxury that can’t be given out for free. Ireland never emotional evolved to expect the state to be socially responsible for its citizens. There are a million and 1 ways that it could be funded.
Forcing doctors to work for free = utopia
The state of the health care is disgraceful. And doctors are exempt from paying income tax!
So what happened to all that lifetime of tax people paid???
Where did it go?
Most other European countries can provide a better health service in general than Ireland. So why can’t we? Call it mindset or laziness, incompetence, greed and vested interests, they all play a part.
For legal advice on any medical issues in the north east visit http://droghedasolicitors.ie
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