Money Times - May 1, 2018

Posted by Jill Kerby on May 01 2018 @ 09:00


Discussions between the Department of Health and the nation’s General Practitioners are underway, and for all our sakes, we have to hope that they go well. The alternative – more early retirements, more emigration, more villages and towns without a family doctor - is not an outcome that anyone would welcome.

Pressure on the Irish GP service has been ramping up for the past decade as a result of the government’s austerity measures or FEMPI, the financial emergency measures in the public interest that were imposed after the 2008 economic crisis.

The c38% cut in doctor’s fees and support income for staff salaries and overheads, and more recently, the adding of the under-6s to the GP patient rolls has ramped up an existing crisis that can only be remedied by a comprehensive and properly funded new GP contract.

Restoring that money however, will cost about €120 million extra a year, about the same amount that the HSE is in deficit, per quarter, and productivity is still an issue, says the government.

The doctors meanwhile insist it isn’t just about money, but also about the mountain of paperwork and regulations, and the bureaucratisation of their health care that they argue has diminished their ability to properly do their real job, caring for the medical needs of their patients.

And those patients are getting older: as a nation we are living longer, surviving complex and complicated illnesses and conditions, but without the proportionate scaling up of access to in-hospital treatment in particular, let alone better community services.

Recent surveys by the Irish College of General Practitioners show –thankfully - that more young medical graduates want to become GPs, but also that nearly 20% of new GPs emigrate to countries where both pay and conditions are better.

Another worrying set of statistics is that while there are now over 20 million GP consultations annually in Ireland, we only have about 76 GPs per 100,000 population while in Canada and Australia that GP per population ratio is 100 to 100,000. Meanwhile nearly one in five of our GPs are over 60.

Not only do we need more family doctors in Ireland, but they need to be better remunerated for the average 50 hours a week they spend in their surgeries.

Under our General Medical Services scheme, GPs are a paid a single annual payment per medical card holder and while these amounts differ, depending on the patient (adult, child, nursing home resident, etc) it averages at about €9 per month, or €108 annually. (A doctor treating a private patient can expect a fee of between €50-€60 per visit.)

The GP shortage in the UK is even greater than here. Visits are free but waiting lists are long and doctor’s earnings are down 11% since 2008. Last year their number fell to 34,592 compared to 33,872 in 2015.

But the biggest concern there – and one we need to be aware of - is the waiting time for a GP visit. In a 2016/17 survey of its members, the Royal College of General Practitioners found that patients had to wait more than a week for an appointment on over 80 million occasions, which they estimate will rise to 102 million by 2022, even with the promised recruitment of another 5,000 GPs. Despite considerable improvements in community care for the elderly in the UK, A&E presentations are soaring. (There is no A&E charge in the UK, as there is here.)

In Ireland GP waiting times are not the issue that they are in the UK, mainly because about 55% of the population are required to pay for their visits and a relatively large cohort with private health insurance have outpatient benefits that pay for all or part of the GP fee. (Popular healthcare cash plans, like HSE.ie also include GP cover.)

Are we moving closer to a UK model for general practice with everyone entitled to receive free visits and treatment?

That seems to be the government’s intention and many Irish doctors heartily approve.  But not all GPs believe free visits are workable until both their numbers and the pay they receive increases. If their annual general meetings are anything to go by, many continue to express their contempt for the HSE’s poor track record in managing and allocating existing resources and especially the chronic shortage of both hospital beds and community care services for the elderly.

Meanwhile, if you don’t have private health insurance and you don’t qualify for a medical or GP-only card, you certainly should be setting up a household contingency or emergency fund that can be dipped into to help pay for unexpected medical expenses like GP bills, A&E visits (when you don’t have a GP letter), or the €75 public bed charge for an overnight hospital stay.

Being ill is enough of a personal crisis without turning it into a financial one.

(The new TAB Guide to Money Pensions & Tax 2018 is now out. See www.tab.ie for ebook edition.)  


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