Health cutbacks - GPs’ action will impact on services

With relations between the Government and the country’s doctors already strained, yesterday’s move by GPs to withdraw from primary care teams and other work not covered by the medical card contract has effectively set both sides on a head-on collision course.

The bitter war of words over cutbacks as witnessed in dealings between the medical profession and Health Minister James Reilly has now reached a climax of direct action by GPs. The worrying development from the public viewpoint is that this row will result in the immediate withdrawal of doctors from primary care teams, community intervention teams, and clinical care programmes involved in chronic disease treatment.

On the face of it, GPs appear to have a valid complaint that last week’s 7.5% cutback in their fees for treating medical card patients effectively takes over €150m out of services they provide for patients, thus bringing their slice of the health budget to below 2%. Yet, they can expect little by way of public sympathy. Compared to nurses, who work as hard as doctors but earn far less, GPs are well remunerated for their work in the health service. Whether they like it or not, the question on most people’s lips is ‘when did you last meet a poor GP?’.

Dr Ray Walley, chairman of the GP emergency committee of the Irish Medical Organisation, claims doctors up and down the country are experiencing financial difficulties, with a small number facing bankruptcy. There is no denying that in response to a Government initiative aimed at keeping people out of hospital, doctors have invested heavily in building primary care centres in many towns and villages.

Arguably, based on estimates that almost 90% of illnesses can be treated without people having to go to hospital, GPs have contributed substantially to reducing the financial burden on the health service. Besides helping to reduce waiting lists, extra work taken on by GPs should result in lower state spending on hospital care.

Doctors complain they are doing more work for less pay, and that the 7.5% cut will have a direct impact on the range of services they provide and, ultimately, will mean greater costs for the health service as demand increases on secondary or community care budgets.

The worsening relations between GPs and Mr Reilly will further undermine his much vaunted plan for universal health insurance by 2016. GPs see the latest cuts as ending any Government ambition to proceed with “free” GP care as part of that centrally funded system. Above all, withdrawal of GP services will hit ‘pro-bono’ work not covered by contract. It ranges from routine blood tests for diabetes, to monitoring blood pressure and administering warfarin to combat blood clotting. That loss will trigger an influx of patients to the country’s hospitals, significantly increasing the cost of the health service. The sooner Mr Reilly and GPs go back to the table the better.

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