By Chris Goodey, CEO, National Association of General Practitioners

When GPs refuse to back the Government’s feel-good election plan of providing free GP care for children under six, the public has a right to know why. Free care sounds like something wonderful, and when it’s for children, who could possibly oppose that? Why would GPs be almost unanimously against it?

The truth is that this is about doing what is right rather than what is easy.

The provision of care to all children under-6s comes with the promise of an extra €24 million per year for GPs, at a time when general practice is in dire need of investment.
The easy thing would be for GPs to accept this money and move on. The right thing to do is for them to stand together and demand that vulnerable and sick patients are given priority.

On a daily basis, GPs all over the country see seriously ill people who are already struggling financially in the wake of the recession and are suddenly faced with a health crisis which brings with it the added burden of medical bills. They see cancer patients who are being forced to pay for expensive medication. They are seeing suicidal patients who simply cannot afford to see a counsellor. They see families who may be €20 over the medical card threshold but have a child with asthma and are sacrificing other essentials to pay medical costs. In many cases, GPs are already providing free visits to these patients because they have been abandoned by our public health system.

Even for those patients who do have medical cards, the service is woefully under-resourced. Over the last few years, the funding provided by Government to deliver a general practice service to medical card patients has been slashed by €160 million per year. The Government and HSE have forcibly discouraged GPs from providing house calls to medical card patients. GPs are being required to put patients on lengthy waiting lists for simple tests because the Government will not provide GPs with the equipment necessary to carry out these tests in general practice. Patients are waiting months to go to a hospital for minor surgery or joint injections which, again, GPs are not being supported to do even though they are trained and experienced. In contrast, a private patient can often get these tests and treatments in private centres within days because they can afford to pay for health insurance.

They say a society can be judged by how it cares for its most vulnerable. Those who have a life-threatening illness; those who cannot afford to pay for their own health care and medication; those who have chronic conditions that require frequent doctor visits – these are our vulnerable. It is simply unjust to spend scarce health funds on free care for a healthy 4-year-old when an 8-year-old with leukaemia cannot get a medical card. It is unjust to have one diabetic patient waiting three months to see a consultant because they on minimum wage when another can be seen within a week because they can afford to go privately.

Providing free care to all citizens is a commendable goal. The reality is that it requires major increases in staff and other essential resources. The evidence shows that when people have access to free care, they attend their doctor more often – sometimes up to 5 times more often. General practice simply cannot absorb that level of additional workload in its current state.

For the last number of years it has fallen on GPs to shelter patients from the effects of unprecedented cuts to the medical card system. GPs have strived to deliver the same high-quality, same-day service regardless of the patient’s ability to pay. This has come at enormous personal and financial cost for many GPs. That situation was only ever going to be sustainable for so long. Doctors have shouldered the Government’s responsibilities for long enough.

GPs cannot allow the Government to spend money on a scheme that not only will not benefit patients, but will seriously lower the overall standard of care.

This under-6s initiative has more to do with optics and elections than genuine reform and improvement in the health service. It is based on a naked appeal to the electorate rather than health need. We must remember in all of this that already 50% of our children have an automatic right to a medical card – and therefore free GP care – but sick children do not.
We need to provide free care to those that need it before we start spending money on policies that look good. Health policy cannot continue to be dictated by electoral goals rather than the needs of seriously ill patients.

The NAGP’s 1,200 GPs will continue to advocate for fairness and decency in health policy.
If this Government really wants to create a health system that is based on fairness – as it stated in the Programme for Government – it is time to put politics aside and engage in an open-minded dialogue with us.