Budget must reverse damage done to general practice

How many businesses can survive a drop in payments of 35%-40% from the main purchaser of its services? asks Dr Catherine O’Donohoe.  

At the start of September, I read a headline that Health Minister Simon Harris wants to extend free GP care to all children under 18 in the next five years.

I shook my head then and continue to shake it. I reluctantly signed the under-6 contract in 2015; at present both I and our practice nurse run at more or less full appointment capacity.

Where will any additional appointment time be found in the week for any further inadequately resourced work sent our way?

Does the minister, or his predecessor Leo Varadkar, now our Taoiseach, but also a qualified general practitioner, not comprehend the impact of FEMPI on general practice? Let me presume to explain.

The HSE’s own figures show that from 2008-15, there was an increase of almost three-quarters of a million people having medical/doctor visit cards, but at the same time a 36% drop in payment per patient to the GP in those seven years.

This payment includes all visits to the GP/out-of-hours service, palliative care provided by the GP, house calls, nursing home patient care, childhood immunisations, flu vaccination, methadone treatment, diabetes and asthma cycle of care, all named additional items of service including stitching, ECGs, 24-hour blood pressure monitors, urinary catheters, abscess drainage, removal of foreign bodies from ear/nose/throat, attendance at case conferences, mirena coil/implanon insertion, and so on.

(It does not include the funding GPs give to the out-of-hours services, such as the annual payment of €6,000 that I and my GMS colleagues in the south-east pay to Caredoc for provision of overnight services for our patients.)

Despite the annual headlines regarding GP earnings, is this not good value for an average annual state payment per patient of €226?

It almost seems too good to be true.

When you look at the figures a bit closer, maybe it is. How many businesses do you know that can survive a drop in payments of 35%-40% from the main purchaser of its services?

That figure, by the way, is the business income, not the owner’s income — in this case the GP’s.

If the GP has not been able to cut the costs of running the practice, then the cut is to their take-home pay, as in any other small business — in order to make ends meet and continue service provision and employee commitments.

If the GP is to take a personal take-home cut of well over 35%-40%, how much should that be, before he/she says enough is enough?

The increasing manpower/womanpower crisis in general practice speaks for itself. How many colleagues have emigrated not to return? How many practices have closed not to reopen? How many colleagues have retired and, whereas once they may have returned to do locum work, which is a lifeline for a single-handed GP, as I am, have now had their fill? Who is going to replace all the retiring GPs over the next 5-10 years? How many towns will we have where patients — public or private — are no longer able to register in any of its practices due to them being unable to take on any more patients? How many towns are already in this position?

At the very least, it is essential that next week’s budget demonstrates a heightened political awareness of the need to commit to reversing the damage that has been done to general practice.

In a country where a totally inadequate portion of the national health budget goes to general practice (which is not the same as primary care*), FEMPI reversal should take place for general practice, at a minimum, to bring the FEMPI cuts sustained by Irish general practice in line with those of public servants.

All FEMPI-related reversals should be such as to benefit all practices, for example additional monies for provision of GP care to patients over 70 or nursing home residents — which were two of the cuts. Cuts affecting some practices and not others should not be the ones reversed.

(*Primary care is the portion of HSE healthcare outside of hospitals and encompassing the work of public health nurses, community physio, dietitian, social worker, occupational therapist, home help, speech and language therapist, audiology, and so on).

If ministers Harris and Donohoe and Taoiseach Dr Varadkar feel the above cannot be considered, it is overdue time for them to give us — both GPs and patients — a realistic alternative.

Given the lack of timeframe on the contract negotiations, it is no longer sufficient to tell us to continue to wait for the new contract. This is a matter of national importance and needs executive decision-making now.

It is time to face the reality that the price of not reversing FEMPI for general practice may actually be greater than that of a considered and balanced reversal of it.

Dr Catherine O’Donohoe is a single-handed rural GP in Co Wexford. She is a member of ICGP, NAGP, and IMO. She has written this in a personal capacity.


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