Doctors at the Irish College of General Practitioners a.g.m. inGalway debated the crisis in general practice, but also expressed pride thatit was the only area of the health service that still works, writes DrMuiris Houston, Medical Correspondent
Almost every family doctor who stopped to chat at the annual general meeting of the Irish College of General Practitioners (ICGP) was equally perplexed: why had health not featured strongly in the election campaign? Given the pre-election hype about health being central to the outcome, GPs - who witness the failings of the health service on an hourly basis - were both mystified and annoyed.
Expressing his amazement that health had not taken off as an issue, one doctor said: "I am 21 years a GP and I have never seen it as bad." He described how, on the recent retirement of a consultant in his local hospital, all the patient referrals he had made to him over the previous months were returned with the suggestion he might try another hospital. And, as he pointed out, such patients do not even appear on official waiting list statistics.
Others wondered how the lid had been kept on the health debate despite the frustration expressed by the public. There were even dark mutterings about a cross-party consensus to stifle debate, given there appears to be no money left in the kitty to develop services, no matter who forms the next government.
Although there was considerable debate on the crisis in general practice at the meeting, especially over manpower, there was also a sense of pride that it is the only area of the health service that still works.
General practice delivers 13.5 million consultations a year on demand. Hospitals deliver only 2.5 million consultations with inevitable delays. An analysis of health service spending shows that approximately 8 per cent of the public health spend is on general practice compared with in excess of 90 per cent on hospital services.
However, the level of service for medical card patients has remained unchanged since the introduction of the General Medical Services Scheme. There is no provision for preventive medicine within the system. For example, GPs are not encouraged to carry out cervical cancer screening or to identify or treat the risk factors for heart disease. If you have a medical card, then all you are entitled to is a reactive, fire brigade service.
GPs are worried about young low- income families and those people on incomes just above the medical card limit. A visit to a family doctor in such situations creates significant financial stress. They are likely to delay or even avoid attending, with possible serious implications for their health. In addition, people on low incomes cannot consider preventive check-ups and a pro-active approach to health. These are luxuries to them.
If there is to be an extension of the medical card scheme, it should be targeted at this group of patients in particular, most doctors at the a.g.m. in Galway agreed.
Those who are suspicious that the primary care strategy represents a takeover of general practice by the overly bureaucratised health boards, rather than any real attempt to extend primary care, were probably in the majority. There were harsh words also for the Department of Health. "Since these are the people who have been responsible for the current chaos in the health system, it is hard to see how the strategy stands any chance of success," was an observation that went down well with the audience.
Six months after broadly welcoming the National Health Strategy, family doctors are wary of the lack of movement on its implementation. At this stage, they would rather see more resources urgently directed into general practice.
With 20 per cent of trained GPs leaving the system within five years of graduating, there was much interest in an ICGP Health in Practice survey. This looked at the healthcare needs of family doctors. It found that 70 per cent of GPs feel emotionally drained by their work. Almost two- thirds have been ill and unable to take time off work, which is a direct reflection on the manpower problems. And 66 per cent of GPs never have regular health checks, such as blood pressure measurement or cholesterol screening.
There was also low uptake of hepatitis B vaccination - an essential precaution against one of the major risks of the job.
The message from the programme director, Dr Andrée Rochfort, was that "physician heal thyself" has many pitfalls and is no longer an appropriate approach to the ongoing health needs of doctors. So the provision of health support and a network of doctors and other health professionals by the ICGP was strongly welcomed.
This correspondent attended his first ICGP AGM in Galway in the 1980s. The enthusiasm is still there, but has become somewhat blunted. It has been leavened by the healthy cynicism of those who have seen more political promises broken than delivered upon.