A large turnout of over 80 GPs met with local elected representatives in the Abbey Hotel, Donegal, last Monday (April 7) to drive home the message that there is a crisis in general practice which needs to be resolved urgently, while two days later a massive turnout of GPs in Dublin spread the message to almost every national media outlet.
GPs from Donegal, Sligo and Leitrim showed up in Donegal to
demonstrate their support for the campaign and were joined at the meeting by Donegal TD’s Padraig Mac Lochlainn (SF), Joe McHugh (FG), Pearse Doherty (SF), Charlie McConalogue (FF) and Thomas Pringle (Ind). The Sinn Fein TD for Sligo/Leitrim, Michael Colreavy was also in attendance.
The meeting was chaired by Dr Brendan Woods who opened the meeting with a short presentation on the current situation, and how general practice was being dismantled as a service which could provide a full range of services for patients. He then introduced the first speaker of the evening, Dr Karena Hanly.
Dr Hanly spoke about the importance of a GP to a community and noted that a GP followed a patient from the cradle to the grave. “We take on everything,” she said, “not just the physical but the social and psychological aspects of a patient’s life.”
Dr Hanly noted that it took a minimum of 10 years to qualify to be a GP and that 95% of all patient consultations which took place in Ireland – 24 million consultations per
year – took place in general practice. Despite this, less than 3% of the overall health budget was allocated to general practice.
She told the meeting that Ireland had to invest properly in general practice and suggested that increasing the portion of the health budget allocated to general practice would
be one way to achieve this. She said that if Ireland invested an extra 1% of the health budget each year for the next five years, we would begin to match the funding of general practice in the UK – which stands at 8% – and noted that the Royal College of General Practice in the UK had said that the safety of patients was at risk because of low levels of funding. Yet, the UK’s general practitioners had three times the level of funding that Irish GPs receive.
She also noted that Ireland had one of the lowest levels of GPs per capita and the positive aspects of GP care in Ireland. “We are the medical home of patients. We are in the community and part of the community. We provide continuity of care and co-ordination of care.”
She also noted that in February 2008, GPs were receiving €21.30 per visit for a GMS patient. By 2014, that had fallen to €14.23.
She also spoke of some of the anomalies in the system – such as a local case where a radiologist in Letterkenny Hospital was being paid out of the Primary Care budget, yet local GPs had no access to ultrasound unless they paid for it.
She added that the new contract as proposed went against Medical Council guidelines in asking doctors to provide patient information that broke doctor-patient confidentiality.
Dr Hanly was followed by Dr Vincent Brett – a young GP based in Donegal who told the meeting that the current contract meant that GPs were not direct employees of the HSE and didn’t have to endure HSE bureaucracy and regulations, but at the same time they lost out financially.
He noted the value that GPs added to the health system. “It’s important to know the patient that has the disease not the disease the patient has,” he said, and it was this knowledge of the local community that made GPs such a valuable resource.
However, he said, at 35, he was still of ‘no fixed abode’ and there wasn’t much prospect of getting one. Many of his age cohort had left the country and others were planning to go. Rural GPs have been hit the hardest, he said mainly because the FEMPI cuts targeted home visits.
Dr Zach Johnson – who is in his final year of training to be a GP gave the perspective of new and emerging GPs. He noted that after 14 years of effort and training to qualify as a GP, and a significant investment by the state, he, like many others, would now have to consider emigrating.
He said that while being a GP was a tough job – with long hours and career uncertainty – those that became GPs were dedicated to the job and loved it.
“A lot of the GPs we do have are retiring. We are not training enough GPs to replace them. The key issue is that those who train as GPs will not become GPs in Ireland,” he said.
“It cannot be all stick and no carrot. I call on James Reilly to engage in a proper consultation with GPs. The future of healthcare is at stake. If we fail, I fear for the future,” he added.
The TDs present then addressed the meeting. Michael Colreavy SF Sligo/North Leitrim said that what he heard was ‘stark’.
Padraig Mac Lochlainn told the meeting that he was shocked by what he heard. “You are not making yourself heard,” he said, “you have to fight your corner.”
Joe McHugh, the only government representative said: “Trust is broken. We need to start again” with regard to the new contract.
Pearse Doherty said that his party submitted an alternative budget each year and he would try to see how they could find the money to increase funding by 1% per year. He noted that this wouldn’t be easy, but it must be done. He also said that this ‘red flag’ had never been raised with him before.
“I believe in collective bargaining. GPs should be allowed to collectively bargain,” he said.
Fianna Fail TD Charlie McConalogue told the meeting that this government had no vision and that the Minister and the government needed to listen to GPs.
Thomas Pringle said that the contract had brought the plight of GPs to the forefront and claimed: “I was never invited to a meeting like this before.” He said that under current government policy “We’re going to hand over the health service to a bunch of insurance companies.”
There were several contributions from the floor – several of whom touched on the issue of patient safety in the light of over-worked GPs.
The meeting was the fifth in a series of meetings held across the country over the last five weeks. The sixth meeting took place in Dublin last Wednesday (April 9) and attracted large numbers as well as a lot of media coverage.
The meeting attracted almost 500 GPs and was chaired by Cabinteely GP, Dr Stephen Murphy. Dr Murphy opened the meeting with a statement which explained the purpose of the meeting which he said had four components:
- That the FEMPI cuts had left many practices insolvent
- That the under 6’s contract was badly designed, badly constructed and unworkable
- That general practice would ‘flounder’ with the proposal to introduce Universal Health Insurance (UHI) if it didn’t flounder under the under 6’s contract and
- That GPs were united in their opposition to the contract and had already turned out in large numbers at previous meetings.
Dr Murphy then introduced the first speaker of the evening, Dermot Goode, a health insurance analyst, who tried to explain the government’s UHI proposal. He said that since much of the detail was missing, this was a difficult task, but he compared and contrasted various other systems in an attempt to imagine what UHI would mean for GPs. Under the Dutch model, for example, GPs were about 20% better off, but there were issues arising about the size of some practices and the quality of care.
He also noted that ‘supplementary packages’ would most likely be risk-rated, and that therefore people who were prone to serious illness might have to pay more for their insurance if they wanted supplementary cover.
The next speaker was Mr Eddie Hobbs who spoke about the Competition Authority and its role in Irish life. He pointed out that section 4 of the Competition Act described and defined what was an ‘undertaking’. He pointed out that the current case been taken by the IMO was based on the defence that GPs are in fact employees, rather than ‘undertakings’. He also suggested that this might not be a good thing in any case.
Mr Hobbs said that the case before the High Court would most likely not be decided in that forum, and would go to the Supreme Court, where, he believed, the IMO would lose. This was important, he said, because the costs at that stage could run to €3 million.
The next speaker was Dr Ed Walsh who stated – as he has at previous meetings – that money was not a problem in the health service, but rather how that money was allocated. He said that the media spin on what doctors earned was wrong, and that the HSE were deliberately misleading the public on this.
He said that the HSE was a bloated organisation with layers of management that were unnecessary, and that if Ireland operated its health system as efficiently as other countries, it could manage on even less money than it does now.
“There are 110,000 people in the HSE – more than the city of Galway. And there are 2,000 in human resources alone to manage them,” he said.
On the other hand, Ireland had only about 40% of the consultants of the average OECD country and 50% of the GPs.
The next speaker was Dr Aifric Boylan – a young GP who is planning to emigrate. She said that while she had no wish to emigrate, she was being left with no choice as buying into a practice or setting one up was not practical, as they were small businesses which were losing money, and this didn’t look like changing soon.
She quoted some of the statistics that emerged from her own research into general practice in Ireland. It showed that 41% have been unable to replace equipment, 56% were unable to afford locum cover, 35% take a week or less in holidays each year and 10% had not even taken a week.
She said her survey also showed that one in five practices had let a doctor go.
“I cannot tell you how demoralising it is to be told you’re earning too much when you’re just surviving,” she said, and that the stress and burnout caused by the cuts would sooner or later take their toll.
Dr Boylan received extensive applause and a standing ovation from the floor.
She was followed by Dr Ciara Kelly – a GP from Greystones, Co Wicklow – who qualified in 2001. She said that it was increasingly difficult for GPs to provide the proper standard of care that they wanted to. She noted that in the UK, general practice got 8% of the total budget while here it was less than 3%. She said that Irish GPs were incredibly lean and cheap by any standard.
“We are angry, we are sorrowful, we are in despair about our jobs,” she told the meeting. “Think long and hard before you dismantle the one part of the health service that works.”
Dr Kelly also received a huge standing ovation from the floor.
Dr Liam Lynch was the final speaker. He said that, despite the assertions of the Competition Authority, general practice was not an ‘internationally traded service’.
“I’m in Clondalkin. I occasionally see a patient from Tallaght. I occasionally see a patient from Lucan,” he joked.
As an experienced GP and as someone who has been involved in medical politics for many years, he noted that the situation now was worse than ever. “We have more models for healthcare than you would see on a catwalk,” he said, but whatever model was used, the problems of general practice had to be addressed.
There followed a discussion from the floor including contributions from some of the 17 TDs present including Richard Boyd-Barrett (PBP), Billy Kelleher (FF), Dr Liam Twomey (FG), Mary Mitchell O’Connor (FG), Caoimhghin O Caolain (SF), Roisin Shortall (Lab), Damien English (FG), Eoghan Murphy (FG), Dessie Ellis (SF), Andrew Doyle (FG), Anthony Lawlor (FG), Catherine Murphy (Ind), Bernard Durkin (FG), Robert Dowds (Lab), Helen McEntee (FG), Brian Cowen (FF) and Shane Ross (Ind).
The meeting has received extensive coverage in the media with stories in the major newspapers and on television and radio.