The NAGP met yesterday (31st January 2014), with Minister of State at the Department of Health, Alex White. The Minister outlined the department’s plans for the introduction of free at the point of access care for all children aged under six.
The NAGP delegation found the meeting itself useful. At the outset the NAGP established an acceptance from the DoH and the HSE that general practice was indeed underfunded. It was also acknowledged that in order to role out any type of universal health scheme in the future that general practice would need to be adequately resourced.
The NAGP sought and got a commitment from the Minister that funding must be diverted into primary care from secondary care as part of any reform.
The NAGP delegation made short representations to officials from the HSE and the DoH, outlining our concerns that introducing free GP care for the under sixes was a morally bankrupt scheme which is not founded on any medical or economic evidence. We informed him of the fact that free GP care is being withdrawn from patients who are genuinely sick and who are in dire need of a medical card.
In addition, having now had time to review the draft contract and having received feedback from members throughout the country, the NAGP National Council expressed grave concerns regarding the process that has occurred over the past 24 hours. The NAGP believe that the implementation of this new contract in it’s current form is now impossible.
The NAGP would contend that the scheme for under sixes is politically motivated and intentionally being imposed on the Irish public with minimal thought and without open negotiations with general practitioners.
The NAGP has been against this policy on the basis of its patent lack of evidence based planning, its negative effects on patient safety and the loss of timely access to the doctor for the genuinely ill. If this scheme was to go ahead it would put a huge increase in work burden on an already creaking system. It would definitely result in waiting lists for GPs and shorter, less satisfactory lengths of consultations.
In a survey conducted last week by the NAGP, of the 720 GPs that were surveyed only 3% stated that they will definitely take part in the proposed scheme for free GP care for children aged under six. The results suggest that as currently structured the Government may not have sufficient doctors for its scheme to operate.
The NAGP feels that if the government is serious about true reform in the current economic climate, then they should engage in open and bilateral negotiations with GP representatives. In statements to the Irish Times yesterday (by Minister Reilly) and today (by Minister White) the government confirms that they will NOT negotiate with general practitioners.
The current GMS / Medical Card contract is outdated and not fit for purpose. It is more than 40 years old and was designed for acute care (i.e. recent illnesses). At that time only 23% of the population had medical cards. Today, 44% of the population has a medical card. Patients present daily to their family doctor for blood pressure monitoring, asthma assessments and cholesterol screening etc. These are all chronic conditions and were never part of the GMS contract as negotiated 40 years ago. However, Irish GPs gave this care on a pro bono basis to their patients. With savage cuts of over €160 million from the budget of general practice in the last four years, Irish GPs have had to work within the confines of the GMS contract.
GPs are patient advocates and have always operated in the interest of patient safety and best practice. The under six policy severely compromises both.
The NAGP called on the government to abandon this policy and engage in meaningful and bilateral negotiations with general practitioners so that Irish people can get the best care in a time of limited resources.
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