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GPs have just received the new contract governing care of under sixes. It has been described as sweet and sour. It gives a cash injection to practices that are in financial difficulty after disproportionate FEMPI cuts but does not give back grants that will allow rural practice to survive.
It recognises that general practice is the best place to do chronic care like asthma and diabetes, but possibly undervalues the cost of providing this care. A new contract that covers all aspects of GP work is promised. There are, however, negatives.
GPs are asked to give free medical care based on age, not medical or financial need, they are asked to measure children without evidence that it is effective and with few community dieticians to refer to. It will increase pressure on already busy surgeries during the day and out of hours. It removes private fees that help run the practice and replaces them with “fees set unilaterally by the minister”. The NAGP ( National Association of GPs) is not recognised despite the fact that nearly half of GPs are now members.
The minister has made it clear that any reversal of FEMPI for GPs is linked to taking on more age cohorts and increased workload yet we already face a shortage of GPs so waiting lists are inevitable. GPs who do not sign up will have all their U6 patients, including those who already have medical cards moved to a GP down the road to one who does. They risk losing entire families, maternity and vaccination payments and potential financial ruin. They have been told if they do not sign, the badly needed funding will go elsewhere and there will be no new contract.
They have been told that chronic care will be handed over to the corporates – so the squeezed middle can get free GP care which could have been done by lowering the income threshold for doctor visit cards. The government’s plans are for universal health insurance. Families will then pay an insurance premium for their politically popular “free GP care”.
By that time, how many more GPs we will have left? A lot of GPs feel they have a gun to their heads. The IMO can advise but cannot ballot its members or call for collective action on this or future changes to the contract in terms of work or fees “through legislation or at the direction of the minister”.
A new contract is promised under the memorandum of understanding. Do GPs trust this government, the Department of Health and the HSE? Have they reason to historically?
GPs have under three weeks to make what is for some a very difficult decision.
Dr Eluned Lawlor
Loughboy Medical Centre
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