GPs to withhold vital services

Family doctors are to stop providing vital services such as monitoring of patients on warfarin in an escalating row with the government over further cuts to the general practice budget.

Yesterday, the Irish Medical Organisation (IMO), which represents about 2,000 GPs, said its members had indicated they would no longer carry out pro bono work which was not covered by the general medical services (GMS) contract.

The IMO’s Dr Ray Walley said doctors would refer patients to hospitals for services such as routine blood tests, warfarin monitoring (an anticoagulant used to prevent heart attacks, strokes, and blood clots), and blood pressure monitoring.

“Many GPs, especially in rural areas, were doing blood tests and not charging the patient and saving the patient the trip to hospital. Now they will be referring the patient to hospital. Many others were looking after warfarin management, they also will be referring patients to hospital, which involves a minimum of 12 visits a year,” he said.

Regarding blood pressure monitoring, the “software and other paraphernalia” involved were expensive and “that won’t be dealt with”.

The IMO has been on a collision course with the Government since it announced further cuts in fees to GPs under the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009. The IMO claims the latest round of cuts, yet to be enforced, mark the abandonment by the Government of any ambition to proceed with “free” GP care as part of a system of universal health care. A total of €150m has been cut from the GP budget since the current crisis began.

The IMO said it is also withdrawing from primary care teams, first mooted in 2001 as the most effective way to deliver primary care. As of last September, there were 417 such teams according to health minister Dr James Reilly, providing services for 3.8m people.

Dr Walley said they were withdrawing from the teams to highlight that they were no more than “a charade”, “a tea and bickie exercise” that took place once a month, and were pointless and poorly attended.

The IMO is also withdrawing immediately from community intervention teams, designed to carry out interventions in the community and reduce hospital admissions; and from clinical care (chronic disease) programmes, such as the national diabetes programme.

All of this will put more pressure on hospitals, the reverse effect of what the Government envisaged for primary care which it has claimed can meet up to 95% of people’s day-to-day health and social care needs.

Last night the Department of Health reiterated Dr Reilly’s comments that the planned reductions in GP fees and allowances were “fair and reasonable”. The department said the minister would respond to correspondence from the IMO.