Doctors concerned over decision to extend free GP care to additional 430,000 people

Family doctors have expressed concern over the Government decision to extend free GP care to 430,000 additional patients, saying that the move will result in a beleaguered profession being put under further pressure with consequences for the quality of patient care.

Dr John O’Riordan, a GP at Sullane Family Practice in Macroom in Mid-Cork, said that while no GP had an issue with increasing access to medical care for people, unless the expansion of the GP visit card system was properly resourced through the employment of more GPs, it would lead to problems.

“We’re already overstretched – there just aren’t the bodies in general practice to provide the service that people are expecting. As it is, there are increasing waiting lists now to see GPs and that wasn’t the case ten years ago,” said Dr O’Riordan, one of four doctors in a practice with 10,000 patients.

“My fear is that we will end up like the UK where the health secretary was saying recently that she was hoping people will be able to get appointments with their GP within two weeks and I think that will be the case here whereas people were used to being seen either on the day or within 48 hours.”

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Dr O’Riordan said GPs are barely keeping up with their existing workload and it was not unusual for him to work seven days a week to keep up with the paperwork generated by seeing so many patients in his practice which currently break down 40/60 between public and private.

“I think every GP is working at the limit – it’s a seven days a week job – I’m just doing referrals and paper work at weekends, going through blood results on a Sunday evening because you know, come Monday, you’re going to be under pressure. It’s just an avalanche of stuff at the moment.”

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Dr O’Riordan said the problem comes down to the lack of GPs in Ireland.

“While they have increased the numbers in training, it takes time for that to filter through and we have a retirement crisis in the offing in the next few years when significant numbers of GPs will be retiring. Unfortunately this is going to impact on patients who are trying to get appointments.”

Dr O’Riordan’s comments are echoed by fellow Cork GP, Dr Bertie Daly, one of four GPs at the 4,000 patient Ath Trasna practice in Newmarket in North Cork, who said there is a major retention problem within the profession with many new qualified GPs opting to emigrate.

“We need to make General Practice more attractive to persuade people to stay but to do that we need to support it properly. To unilaterally introduce what is a badly needed service for many people without proper matching resources is unfortunate and something I fear we will regret in time.”

He said GP practices have always worked in an egalitarian way to look after the most vulnerable and no doctor would dispute the need to extend free GP care to those most in need, but it must be done with proper supports in terms of adequate numbers of GPs, practice nurses and secretarial staff.

He said the evidence internationally was that providing free GP care increases the number of visits people paid to their GP and the average visiting time in Ireland for somebody with a GP visit card was between seven and ten times a year, compared to four visits a year for private patients.

“A lot of those visits by people with medical cards are based on need and many of those coming are from disadvantaged backgrounds with a bigger disease burden and early intervention can lead to lifestyle changes but some do not have that need and that’s going to generate extra visits.

“That might suggest we want to keep people out – we don’t. We want to see those most in need at the most opportune time and intervene appropriately. I think the initiative to provide more cards is good in its own right, but we need to identify those most in need and support them in the best way.”

Dr Daly added: “This expansion takes no account of our behind-the-scenes work – the official finishing time for medical card patient is 5.30pm but this is a fallacy – there is no full time doctor that is not doing 80 hours a week, completing paperwork in the evenings or at weekends in order to catch up.

“If you substantially change the number of defined consultations as will happen as a result of this move, you either provide more consultations which is limited because we have a finite workforce or you shorten consultations which isn’t advisable or you delay consultations – something has to give.”