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I am quite surprised by the lack of media interest in the controversial government draft contract for providing free medical services for children under six. It is a publication of national significance as it clearly highlights how it plans to introduce free general practice services to the whole population.
Currently, we have the most “pro-poor” general practice service in Europe which compensates somewhat for the “pro-rich” hospital service. However, that is changing. Over the last year, GPs have seen patients at the fringes of society, and not able to cope with HSE bureaucracy, being deprived of full medical cards on “probity” grounds. Also more of the patients with the highest medical needs in society are being refused discretionary medical cards.
Intuitively, a lot of the proposals in the document sound like a good idea, but unfortunately little of it stands up to critical analysis. It proposes a massive diversion of clinical and administrative resources from evidence-based patient care into unnecessary bureaucracy and clinical activity. Mandatory universal “wellness assessments” is in direct conflict with the best international evidence. It is well proven to waste valuable healthcare resources and contribute to health inequalities via the inverse healthcare law; those with higher healthcare needs are less likely to avail of universal wellness assessments.
This draft under-6s contract serves to highlight the extent of the senior public health service managers’ dysfunctional mindset and their desire to bring under their command and control the currently independent GP service. To dispense all the responsibility of general practice to the GPs but to gain total authority over how it functions. It wishes to change a very responsive and equitable healthcare service into a universal population monitoring role. It is clearly trying to instil its own brand of bureaucracy-centred inefficiency similar to what afflicts other areas its tentacles extend into. More sinister, it contains a very Orwellian gagging clause which would prevent clinicians from performing their role as patient advocates.
This document only serves to highlight how detached senior public health service managers are from reality. Their ill-conceived plans are clearly based on politics rather than common sense. I cannot imagine that any of my competent GP colleagues will sign it on ethical grounds, as it is an assault on evidence-based, patient-centred care.
That will be the first nail in the coffin for all James Reilly’s subsequent plans for universal health insurance and “free GP care”.
William Behan GP
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