GPs should have a policy input

The Health Minister James Reilly has reportedly warned GPs that government — not doctors — sets policy. This statement was followed up with the Cabinet approval of free GP care for the under-6s.

This opinion would be at odds with World Health Organisation policy, which promotes front-line clinician involvement in local and national health policy development.

The architects and town planners were mostly ignored during the building boom, leaving a legacy of missed opportunities that will blight our environment for generations. Our economists’ opinions were similarly dismissed, with devastating effects on the State’s finances.

In good general practice, the patient has an ongoing relationship with an individual clinician. Allowing patients the opportunity to attend their own, named GP reduces unnecessary investigation, referrals to hospital, admissions, surgical interventions and death rates, as compared to other models of care.

There is little evidence to support the national-policy construction of primary-care buildings and increasing primary-care administration.

Planned under-6s policy will only damage the same-day service with a knock-on impact on the rest of the health system. It will further damage the ‘pro-poor’ general practice system. We know that we are the most equitable part of the health service, and refusing discretionary medical cards was the beginning of the Government’s attempt to change this from a ‘pro-poor’ to a universal primary care system, in which the richer and educated will disproportionately benefit.

Unfortunately, it has been suggested that the Government plans to automatically convert under-6s medical-card patients to the new contract terms and conditions. This heavy-handed approach to engagement with the relevant stakeholders will probably result in GPs nationwide applying to the HSE to have this cohort removed from their lists on practical and ethical grounds. All children under the age of 6 will then become private patients.

I would be interested in government health policy if I thought it had any significant merits and if it appreciated the essence of general practice. However, the more I look, the more it appears to promote the corporatisation and commoditisation of healthcare. This will only cause the fragmentation of its delivery, which merely benefits bureaucracy by increasing unnecessary administrative activity. I do not see the relevance it has to the real world of patient-centred care.

Dr William Behan

Cromwellsfort Road

Dublin 12