The weekend meeting in Westport of the Irish College of General Practitioners (ICGP) provided a useful and pertinent reminder of the fundamental importance of general practice in the current development by the Government of a new national health strategy. Traditionally, the family doctors have been the cornerstone of an efficient, equitable, economic and caring service for all. There is every reason why this should continue to be the case in the century ahead. They have acted as the gate-keepers to the vastly more expensive hospital system insofar as they have provided their patients in need of secondary or tertiary care with the necessary referrals to particular hospital specialists.
Yet in recent years they have found increasingly that they, who best know their patients' needs, must send those patients requiring hospital admission into the maelstrom of accident and emergency departments where junior hospital doctors who don't know the patients at all and who have less experience than the GP must re-assess the case for admission. Health care systems in the United States, where more is spent on inadequate health care than anywhere else in the world, give ample demonstrations of how not having skilled gate-keepers to the hospital system can escalate costs for all concerned.
There is much to be said, therefore, for a system in which every citizen should register with the general practitioner of his or her choice who would then undertake the task of integrating the comprehensive care (including appropriate hospital referrals when necessary) of every patient. And universal patient registration (UPR), as the ICGP has dubbed it, has the additional merit of enabling the GP to provide or arrange for effective preventive tests and measures for each of the patients on his or her registered list.
This kind of comprehensive care and prevention will very likely require a strict limitation on the number of patients each GP can take on the practice register. More GPs will almost certainly be required. There will also be a need to develop a sense of partnership between GP and patient in every transaction undertaken between them. There is ample scientific evidence to show that where the participants undertake these transactions in a sense of partnership rather than in the autocratic model where the doctor tells the patient what to do, the outcomes - whether therapeutic or preventive - are more effective and more successful.
And the ICGP was absolutely correct to tell the Government that it is folly to give the Medical Card to all citizens over 70 years of age, regardless of the size of their pensions, when many much needier younger people and families are still without the health benefits that a medical card could, and should, bestow upon them. In this, the College showed that it is more concerned with health needs than with patients' purses. The Government still seems to need to learn that health care should be provided on the basis of medical need rather than on the basis of ability to pay.