Mixed reaction to new 10-year plan for free GP and hospital care

There has been a mixed reaction to the 10-year plan as outlined in the Committee on the Future of Healthcare report published today.

The report has recommended investment to provide free GP and hospital services to all, reduce waiting lists to a maximum of 12 weeks and the phased elimination of private care from public hospitals.

The Irish Cancer Society has welcomed it, saying it "represents a unique opportunity to revolutionise Ireland’s health system for the better".

Donal Buggy, Head of Services and Advocacy for the society said at the moment cancer patients face many difficulties in the health service at the moment.

These include delays in accessing diagnostic tests for cancer, difficulty getting a medical card, difficulty affording costs like the €80 in-patient charge when undergoing chemotherapy, and difficulty affording their prescription medications or the prescription charge.

He said: "We have heard from cancer patients in serious financial distress who were receiving letters from debt collectors in relation to their chemotherapy inpatient charge.

“We are delighted that the Committee has recognised these struggles and echoed our recommendation to scrap hospital charges and reduce the prescription charge and drug payment scheme."

However, the Irish Medical Organisation (IMO) claims the report was undermined by its "inadequate funding and capacity recommendations" which they say "grounds many of its proposals on simple and flawed assumptions".

Dr Ann Hogan, President of the IMO, said: "We can all agree that healthcare should be delivered on the basis of need rather than ability to pay and that, in an ideal world, such a system would provide all care on a universal basis which is free at the point of access. However we do not believe this report will in fact deliver upon that goal given the wholly inadequate funding and capacity recommendations.

"In particular the failure to sufficiently and credibly address the capacity issue across the services both in terms of staffing and infrastructure is a major flaw."

    The IMO outlined three concerns:

  • Introducing GP Care to the whole population over five years is NOT achievable given the current problems with capacity and funding in General Practice

    The current problems of capacity and lack of funding in General Practice makes this proposal unachievable in the short to medium term. Such a measure cannot and should not be considered until General Practice is stabilised and has sufficient resources. It can be accurately predicted that the number of visits will double on the introduction of universal care and the report takes no account of the ageing patient profile which in and of itself will increase visitation rates.

  • Ceasing to provide private care in public hospitals will NOT address the capacity problem

    There is no evidence backed assessment of how this measure would increase capacity in our public hospitals nor any analysis of the impact of the loss of indirect co-payments on budgets in public hospitals, payments on which hospitals rely upon to deliver services to all patients. This proposal fails to recognise the right of all citizens to avail of publicly funded services, regardless of whether or not they hold private health insurance and what affect such a measure will have if there is any significant trend among the population to cancel private health cover.

  • The number of additional consultants (593 from Year 4) recommended by the Report will NOT deliver a consultant delivered service to patients

    The current level of consultant manpower in Ireland falls well short of the OECD average and additionally the National Task Force on Medical Staffing recommends that we need in the region of 2000 additional consultants to treat the current patient profile and with further numbers required as the population ages.

The National Association of General Practitioners (NAGP) said that reinvesting in general practice to make it more viable and a new GP contract will ensure that some of the report's recommendations can be implemented.

The NAGP said that the number of GPs, practice staff and practice nurses needs to be increased and it can be done so partly by "unwinding the disproportionate FEMPI cuts imposed on general practice".

Dr Emmet Kerin, President of the NAGP, said: "This report will help take politics out of health and give direction and clarity to the decisive shift to primary care that is required to redress our current failed hospital-centric model of care.

"Progress on a new GP contract has been too slow and fragmented. At the current rate, we are unlikely to see a new contract agreed within three years. A new fit-for-purpose contract would underpin much needed reform in our primary care health service. Failure to produce a timely new contract would be an unforgiveable obstacle to the delivery of the vision set out in this report."

Dr Kerin went on to say that the report brought up "many positives...and many challenges".

He said: "Extension of free GP care over five years, while utopian, will currently destabilise an exhausted service, already working beyond safe capacity, unless realistic funding, manpower and infrastructural supports are front-loaded into general practice and agreed by all the parties from day one.

"The near-universally negative GP experience of the introduction of free GP care for under 6’s is a barrier to the implementation of this report as the day-time and out-of-hours service was overwhelmed not by ‘unmet need’, as stated by the committee, but by unyielding demand for free access for minor self-limiting conditions of low acuity which displaced access and clinical time for more appropriate GP consultations, including the sick and frail elderly. This added to the trolley crisis of 2015/16."

He said in order to avoid repeating this a new GP contract needs to be negotiated.

Dr Kerin said: "Without such an agreed contract the report cannot be implemented effectively."

He also asked for an independent impact analysis to be carried out on the separation of private practice from the new, publicly funded, free-GP scheme in order to avoid any unintended consequences.


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