Madam, – Department of Health documents are reported as stating that the cost of providing GP out-of-hours service in the Republic is about four times that in Northern Ireland for the same number of patients (HEALTHplus, January 19th). The figures are both inaccurate and misleading. The population figure of 1.6 million used in the review document stated for Northern Ireland refers to total population while the 1.6 million in the south refers only to medical card holders. This would imply that the HSE and the Department of Health have no obligation to the out-of-hours health needs of those patients not in possession of a Medical Card.
In Northern Ireland 30 per cent of the budget for GP co-ops goes towards the administration of the service while 70 per cent is paid to clinicians. Here, only 45 per cent of funding is for frontline clinic. The remaining 55 per cent of the costs goes on administration of co-operatives, mostly HSE, however it is worth noting that only 70 per cent of the population is covered by the co-operatives.
Further, 480 GPs in Northern Ireland cover a geographic area of 5,400 square miles compared to 2,500 GPs in the Republic covering an area five times larger at 27,000 square miles. Here, eight out of 10 home visits are to medical card holders.
In the south, GP co-ops and hospital emergency departments are the only services available to patients after normal working hours. Patients in Northern Ireland have 24-hour access to social services, child welfare services, palliative care, dental and psychiatric care along with a number of minor injury units. These cost are not factored into the Northern Ireland figure, nor is the increased workload of GPs in the South as “Transformation” closes hospital emergency departments and moves more care into daytime GP and out-of-hours setting without resources.
GPs have been willing to negotiate with the HSE on this issue.
Reducing doctors’ fees is already part of the discussion. However, their proposal involves cuts of 55 per cent which threaten this essential frontline service nationally. As long as the department and the HSE continue to delude themselves with the myth that all funding difficulties associated with the provision of out of hours care is caused by doctors’ fees, little progress can be made. – Yours, etc,