A LEADING GP has warned of the risks to patients and the health system of the corporatisation of general practice.
Dr Ronan Boland, chairman of the GP committee of the Irish Medical Organisation (IMO), told The Irish Timeshe is concerned that allowing companies to employ GPs as part of the planned development of primary care teams could threaten doctors' independence and diminish the quality of care offered to patients.
“In some cases already in the Republic, doctors have been approached by companies to become employees. While this may be attractive to some in the short term, the experience of corporatisation elsewhere is that it results in a loss of independence, a reduced service to patients and the inappropriate use of investigation facilities such as X-rays and blood tests,” Dr Boland, a Cork city GP, said.
The IMO has issued a business guide to developing primary care centres to its GP members which outlines a number of market-based models for primary care. This follows an announcement in this year’s budget that the Government wants the HSE, in conjunction with the private sector, to develop primary care teams in almost 200 locations throughout the State.
According to the guide, “research both nationally and internationally points to five options for alternative market-based models of primary care”.
However, it says that Government objectives essentially narrow the options here to either a “takeover” or “merger” model.
Outlining the commercial takeover approach, the IMO says this may involve space being rented to GPs, or it could involve doctors being directly employed by the operator.
However, in situations where GPs are employees of companies that have also developed on-site X-ray facilities and laboratories, there is concern that doctors may be pressurised to practice in a certain way so as to increase the volume of tests being carried out to drive the diagnostic side of the business.
“The experience in North America and Australia is that this has not been good for patients and the IMO has a big issue with this approach,” Dr Boland said yesterday.
The guide outlines different aspects of merging existing practices, from co-location of individually owned medical practices without shared services to full practice amalgamation under a single trading company.
Meanwhile, in a position paper on suicide prevention, the IMO calls for the full implementation of the national strategy for action on suicide prevention.
The doctors’ representative organisation specifically recommends school-based projects which promote self-esteem and problem-solving among young people. It suggests a targeted approach to the issue, such as the provision of suicide-prevention services in hospital accident and emergency departments.
The IMO also recommends that “the inequalities in mental healthcare provision for adults and the underprovision of appropriate psychiatric and mental health services for children and adolescents” be addressed by implementing recommendations in the report of the Joint Oireachtas Subcommittee on the High Level of Suicide in Irish Society.