THE DECISION by the Government to cut the fee paid to general practitioners to do house calls after hours is likely to result in hospital emergency departments being flooded with patients, doctors have warned.
Speaking on the third and final day of the annual general meeting of the Irish Medical Organisation, Dr Ken Egan, a Mayo GP, said several family doctors had told him they would call an ambulance for patients living 20 to 30 miles from their surgeries and ask them to take the patient to hospital rather than go and see them at night and be paid just €45 for the work.
This figure was down from €93.24 since the fee for out-of-hours house calls to medical card patients was cut by 53 per cent in December’s budget.
“GPs have said to me they have drastically cut back on the number of house calls that they’re doing. I have done it myself . . . I have to make a living, I have to run my practice – if it’s not going to pay me I have to look at that as well,” he said.
There has been an increase in emergency department presentations in the first two months of this year, driving up waiting lists for hospital surgery, and Dr Egan believes the change to the rate of pay for house calls is contributing to this. The emergency department at Galway University Hospital was already “getting flooded”, he said.
Dr Ray Walley, a Dublin-based GP, said the cut was “a savage imposition” on GPs in rural areas in particular and was “classic penny wise, pound foolish” as it would cost significantly more to get ambulances to do the work.
East Galway GP Dr Aonrai Finnegan claimed the cut would be the death knell of house calls. It was a fundamental attack on general practice and he questioned who were the people in the HSE behind this “mean-spirited” initiative that would “squeeze the life” out of this part of the GP’s service. “Fundamentally they are saying the house call is over.”
He explained that a GP from his practice went to visit somebody in the snow on St Stephen’s Day and it took one hour to get there, another hour to tend to the patient, and a further hour to get back. “To think that is valued at €45 is completely ridiculous.”
Former IMO president Dr Martin Daly, a GP in Co Galway, said there was no way a normal-thinking young GP would come and set up in a rural area when this was happening. “The impact is hugely significantly and probably spells the end of general practice in some rural areas in this country,” he said.
The cuts in GP fees announced in the budget aim to save €48 million a year. They were implemented under the financial emergency measures in the Public Interest Act and resulted in a wide range of payments to GPs being cut.
Meanwhile, hospital consultants who are members of the IMO – which represents more than 6,000 doctors in different sectors – are demanding that pay increases due to them under new contracts they signed up to in 2008 should be paid. This is despite a recent pledge by Minister for Health James Reilly to cut their pay further.
Eric Young, industrial relations officer with the IMO, said the organisation’s view was consultants had implemented all the changes agreed under the new contract and therefore should get paid the money due to them. Asked how they could expect it in the current economic circumstances, Mr Young said his view was consultants were public servants who had already been subjected to the pension levy and other across-the-board pay cuts, without suffering further by not having their contracts honoured.
Newly elected IMO president Dr Ronan Boland said the Government was creating a public expectation that it will continue to cut payments to GPs but he warned GPs’ co-operation or acquiescence “should not be presumed upon”.
Some general practices were already cutting nursing and secretarial hours as a result of the previous fee cuts and there was anecdotal evidence of practices “having difficulty extending overdrafts from their long-standing bankers, let alone securing major funding to develop primary care centres as envisaged by the HSE”.