Sir, - I have been following your recent coverage of health matters with interest. I have been concerned however, at the lack of attention paid to one aspect of the A&E dispute. This relates to the "inappropriate" attendances at emergency departments of people with primary care problems.
In recent articles both Padraig O'Morain and Dr Muiris Houston have expressed puzzlement about why people would choose to wait hours in A&E when they could see their own family doctor. The Minister, Mr Martin, has implied that it is to do with lack of out-of-hours cover by GPs, and that the introduction of co-ops will solve the problem.
As a GP working in a part of Dublin with significant socio-economic problems, it is clear to me that a very significant contributor to this problem is cost - i.e. the absence of medical cards among a large part of the population who cannot afford private health care. In principle, most hospitals have a charge for attending casualty. In practice this is rarely, if ever levied. People will therefore choose to attend hospital with primary care problems because it is a lot cheaper to wait six hours and pay nothing, than see a GP and pay €30 to €40. Every GP in the country makes arrangements for out-of-hours cover; it has nothing to do with availability.
This problem also contributes to the "blockage" of beds by people with acute medical problems. I have many patients with chronic problems (for example, asthma) who cannot afford a GP visit when they become ill, and then leave it so late that they require admission for one or two weeks. Many of these admissions could be avoided if patients could afford to consult a GP.
The Minister may have grand plans for the next 10 years, but by extending medical card eligibility he could with one stroke of his pen have alleviated many of the acute hospital problems and simultaneously granted a fundamental human right to many people who currently cannot afford basic health care. - Yours, etc.,
Dr Edel McGinnity, MRCGP, DCH, D.Obs., Huntstown Lawn, Mulhuddart, Dublin 15.