Sunday Mon€y Comment - April 13, 2014

Posted by Jill Kerby on April 13 2014 @ 10:15



If you were on the verge of a heart attack or just needed a prescription filled last Wednesday night, the Double Tree Hilton in Dublin (aka the Burlington) was the best place to be.

Nearly 500 Dublin GPs were gathered to make their feelings known about the draft GP contract that junior minister Alex White claims will be amended and introduced this summer and will introduce free GP care to all children under age six.

Either the minister has found hundreds of millions of euro to solve all the problems related to their primary care service, or he just hasn’t been listening to why they insist the system he is proposing is unfair, unworkable and even immoral.  (Healthy children will take resources from the sick and chronically ill.)

First, some background. 

The NAGP have been holding their town hall-style meetings all around the country since the start of the year…to packed houses. TDs and local representatives are finally paying attention to their complaints about the existing system.  They’ve even found support from the establishment, College of General Practitioners and Irish Medical Organisation (IMO).

Every meeting has set out the fundamental issues that make the idea of extended “free” GP visits to the under-sixes – which the HSE insist will only cost the taxpayer another €37 million – so untenable.  Until these issues are addressed, they say that the introduction of universal health insurance (under which GP care will be a minimum benefit is also impossible:

-       Primary care services have seen cuts of €160 million in the last four years – up to 38% of the original budget - despite becoming a ‘priority’ for the health system. Another €70 million in cuts is earmarked for GP services.

-       Up to100 GP practices are reportedly insolvent as a result in these cuts, including one of the biggest primary care clinics in Dublin, that were set up by GPs prior to the start of the cuts.

-       GPs see 95% of all consultations/referrals as front-line practitioners, but get just 3% of the HSE budget. (This compares to 8% in the UK, where ‘free’ GP care is universal but even that percentage is considered inadequate, according to the UK College of General Practice.)

-       There are 24 million GP consultations in Ireland every year.

-       The percentage of GPs in practice here is 50% of the international norm. (The number of consultants is 40% of the norm.)  Places in the College of General Practitioners are now failing to be filled and young qualified GPs are emigrating in large numbers.

-       It takes over 10 years of study to become a General Practitioner.

-       When the GMS/medical card contract was first set up 40 years ago it was designed for acute care only; 23% of the population had cards. Today, 44% of the population have full or GP only medical cards, including over-70s with individual gross income of up to €500 per week (€26,000 per annum) or €900 per week per pensioner couple. (€46,800 per annum.)

-       The OECD recently ranked Ireland’s health service as one of the most inefficient in the world.

-       The HSE employs 110,000 people, greater than the population of the city of Galway. Over 2,000 of them are employed in the HR department.

-       The GPs challenge a HSE report that 1,000 GPs have received €250,000 per annum in GMS payments. They claim that a GP practice with an average panel of 880 patients receive €59,000 gross per annum after practice expenses such as rent/mortgages, hiring receptionists, practice nurses, locums and equipment, utilities and insurance.

-       41% of GPs have been unable to replace equipment, 56% were unable to afford locum cover.

-       New equipment grants stopped nearly 15 years ago.

-       The proposed average GMS payment per under six will be worth c€75 per annum, regardless of the number of visits. Treatment is expected to include annual health checks per child which include taking blood pressure and noting weight and height changes, which they describe as “entirely unnecessary” for all under sixes. Unhealthy children already receive this monitoring.


The high headline cost of GP visits, especially in the main cities for non-medical card holders is driving much of the Ministers’ doggedness in pushing ahead with this new GP contract and free cover for the under-sixes. 

Middle income families have been hit hard by all the additional taxes, levies and obvious and hidden price increases since the economic crash and in which the state has played such a direct and indirect part in driving up: I refer to health care and insurance, energy, transport, education, banking and legal services. 

These angry GP patients will be voting again soon in local, European and general elections and they are mad as hell.

The dysfunctional, wasteful HSE and Department of Health and their political masters need as many scapegoats as they can get and GPs and their private fees (and the private health insurance companies) are chained to the stake, just waiting to be devoured.

The problem for the GPs, is that they are caught in a deeply dysfunctional system that was not their doing, but in which they are now trapped.

In our two tier health delivery system they are both employee and self-employed.

They are the recipients of a medical education in Ireland at a relatively low financial cost (to them), yet are not required to repay the state for that cost with a compulsory term contract. Once in practice, they collectively receive over €400 million in fees but as that pool of fees falls are still required to run their own practices as private businesses and for profit.

Meanwhile, though they object to cutbacks in previous contract terms they still want (and still receive) a private pension from our bankrupt State for their GMS service.

The angry, disillusioned GPs who have been attending the NAGP town hall meetings – as well as the politicians – have run out road. 

Either they agree to a mutually agreeable and affordable new contract soon or they don’t.  A contract of some sort looks like it will be introduced, with or without the GP’s consent.

They can opt in and tighten their binds to the state, or opt out and treat all their patients as private customers.

But if they opt out they’ll need to adjust their own earnings and lifestyle expectations drastically since this time, the real market of ordinary Irish people, and not the overpaid, out of touch political bureaucracy will dictate what they can afford to pay for their services.

Meanwhile, the younger GPs can always emigrate. Some older, solvent ones can retire to those golf courses where so many people seem to think they idle away every other afternoon.

But if they can’t and join the ranks of the unemployed, they can always ask Joan Burton if she can find them a re-training course …or maybe a JobsBridge place.

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