Sir, – In relation to Isolde Goggin's article "Why GPs don't need collective bargaining" (Opinion & Analysis, August 18th), there are multiple anomalies in the GP relationship with the State. The biggest is the State's dominant or monopoly position as a purchaser of GP services and its ruthless exercising of this dominance as demonstrated by the Fempi (Financial Emergency Measures in the Public Interest) reductions.
Ill health, unfortunately, is inextricably linked with unemployment and poverty.
In 2011, Enniscorthy had an unemployment rate of 31.7 per cent, in comparison to the official State unemployment rate of 14.3 per cent. The demands on GP services are massive in towns such as Enniscorthy, yet the average funding per patient each GP receives is the same across the country.
I would appreciate an opportunity to negotiate a service level agreement and budget directly with the State on behalf of my patients but this mechanism does not currently exist. Again, it’s unclear how competition can be encouraged in areas of high deprivation where GPs are increasingly unlikely to remain in practice. Perversely the State has reduced competition in these towns by using the blunt instrument of Fempi by making practices less viable.
Deprivation indices such as those used in Northern Ireland are used there to support basic and enhanced GP services in areas of deprivation. Would it be anti-competitive for GP practices in one area to receive deprivation payments and for others not to?
While it is true there was a larger percentage rise in State funding to GPs in the seven-year period up to 2008 when compared with the rise in the retail price index for the same period, this was largely due to funding having come from a very low base. Virtually all this increase in funding has now been reversed and little over 2 per cent of the health budget goes to fund GP services, as compared to 10 per cent in the UK. – Yours, etc,
Dr WILLIAM LYNCH,
Enniscorthy Medical
Centre,
Court Street,
Enniscorthy, Co Wexford.