Escalating crisis in GP care must be addressed

IT is often remarked that Ireland ‘did not march’ in response to austerity cuts and that we as a nation have accepted our lot with regard to the bank bailout, cuts to services and increased taxes.

Part of the accepted wisdom of this view is that the cuts were necessary, and brought us back to a kind of ‘normality’ after the boom.

But marching is a very blunt and imprecise weapon. It can say little more than there is something that we as a group want, and, that the preferred timing for the meeting our demands is ‘now’.

However, in the last number of weeks, general practitioners have been meeting in Cork, Limerick, Tralee, Galway, Mayo, Donegal and last night in Dublin, with their local TDs and senators and explaining to them the crisis that exists in general practice. If we have a government accountable to the Dáil, that surely should be the approach to take to create change.

More than 1,000 of Ireland’s 2,700 GPs have turned up for those meetings and after the Dublin meeting, the vast majority of Irish GPs will have turned out to add, not just their voices, but their numbers, to demonstrate that they are all of one mind — general practice is in crisis and will deteriorate even further if action is not taken.

I have been working in the medical field for more than 20 years and in all that time, I have never witnessed GP meetings as large or as fired-up about any issue. Because the issue for GPs is one of survival.

Since the FEMPI cuts (Financial Measures in the Public Interest) have been introduced, €160m has been taken out of general practice. This is the money that is provided to GPs to build their practices, pay staff, provide equipment and ultimately pay themselves.

The problem is that GPs are now in a position where they have to either cut back on services or pay themselves little or nothing for their work. They can cut back on staff or equipment only up to a point — they still, after all, have to provide a service. While hospital consultants and other public servants have seen cuts to their salaries of 10%-15%, because of the way they are reimbursed by the HSE, GPs are now working for little or nothing, and the situation is getting worse each day.

Even if the public had little sympathy for the GPs’ plight, there is a much bigger issue of protecting patients, and ensuring the one part of our health service that had worked is not driven into the ground. GPs are essential to providing the care envisaged by the overall health service whereby large amounts of money could be saved by moving services to general practice — such as the care of the chronically ill and those with long-term illnesses.

WE have been told again and again this is the Government’s approach — to invest in primary care and move services from expensive hospitals to the more convenient and cheaper primary care sector.

But it seems the minister has no control over where the money goes — cuts are being applied to every sector and rather than the money following the patient, the money is staying exactly where it was in relative terms.

The National Association of General Practitioners are not asking for an increase in the health budget. We know the country cannot afford that at the moment. What we are asking for is a gradual investment in general practice to bring us up to international standards.

In the UK, they spend 8% of their overall health budget on general practice. Even still, their primary care sector is not as efficient as ours and we spend less than 3% of our budget on general practice (and some estimates put it as low as 2%). What we are asking for is a transfer of resources of 1% a year from other sectors of the health budget to boost the investment being made in general practice closer to the 8% which is required.

At the moment, GPs are working flat out with long hours and usually about 30-plus consultations a day. We need more doctors and a much better developed primary care sector. It’s the only thing that can, ironically, keep the overall costs of the health sector down. And that has been government policy too for many years.

But what is happening instead is GPs are emigrating, and patients are suffering. If we go below a certain level (which we are approaching) or if even more work is foisted on general practitioners, we will reach a breaking point and waiting lists will have to be introduced.

For the sake of patients and the health service in general, we cannot allow this to happen. That is why GPs showed up in big numbers last night as they have done across the country — to save a service that is vital to every community in this country.

And TDs will be there to listen and to take that message back to government — there is a crisis in general practice and we need to act on it now.

* Chris Goodey is chief executive of the National Association of General Practitioners