Sir, - At a recent meeting of a group of my general practitioner colleagues, Maev-Ann Wren's recent series on the health services provoked thoughtful discussion. Even though we were not mentioned, it was evident that as a group, GPs experience both shame and frustration in trying to work the system for our patients. Shame because the system increasingly favours those who can pay rather than those who need it. Frustration because of difficulties with patient access to hospital and consultant work practices, especially in the bigger urban centres.
The Irish Hospital Consultants Association is probably right in its estimation that the system needs another 1,000 consultants. However, introducing 1,000 new consultants into the present system will not solve problems for long. Consultant colleagues tell me that the current system leaves them short of beds, theatre time, outpatient facilities and specialised investigative facilities. Too often, new consultants are appointed without thought to the need for support staff and facilities.
They typically spend a couple of years cajoling management into giving them the resources to do the job for which they were appointed. Those with sufficient guile avoid the minefield of trespassing on colleagues' resources and harming relationships for years to come. Those without such skills or the inclination to build a service find the lure of the private system irresistible and in a relatively short time are carrying out high-volume, low-level procedures on their own for comparatively modest fees. They become the kind of doctors they derided only a few years before.
The private sector in medicine has a case to answer. With a few exceptions it does not invest in the university training of doctors nor is it, in most cases, capable of training future medical specialists. It has not even taken part in the routine collection of activity data that is important in planning future services. It excels at providing comfortable facilities for common procedures with predictable outcomes. The public system drives our specialists, sometimes easily, into a private sector that helps itself to their hard-won skills and international networks.
Specialists working in both systems also have a case to answer, which is the conflict of interest in trying to spread themselves over public and private patients. They all work long hours, but some are now perceived as working harder and longer for the private sector. They have allowed this to become the main political issue, rather than the matter of a properly resourced public health service. Most people seem to support accountability nowadays. The question now is: will our consultants accept changes that will allow the conflict of interest issue to be addressed? Until they do, their vital role in our health services is compromised. Many of my general practitioner colleagues hope that we will get more resources for health, but not more of the same. And we should know. - Yours, etc.,
Prof Tom O'Dowd, Department of Community Health and General Practice, Trinity College, Dublin 2.