DOCTORS HAVE SAID the government’s plan to extend free GP care to children under the age of eight will mount pressure on a service already near breaking point in many areas.
During the week, the government confirmed that the extension of free GP care, which is already available to children under the age of six, was included in Budget 2020.
The move was criticised by the Irish Medical Organisation (IMO), a body that represents doctors across the country, which said it had not agreed to its implementation.
Denis McCauley, Chairman of the IMO GP Committee, said doctors’ concerns stem from capacity and infrastructure issues.
“When you give somebody a medical card, it’s a fact that they will attend the doctor more regularly. That’s not a judgement, it’s just a fact,” McCauley told TheJournal.ie.
“In terms of any age cohort, there’s an increase in consultations if they have free access, there’s no argument in relation to that.”
McCauley said many general practices are already stretched beyond their limit, with some closing their patient lists as they are already unable to treat any extra people.
He said patients throughout the country are dealing with the impact of the government’s decision to bring in free GP care for certain age groups.
“Patients see the impact of this on the ground because they cannot get onto a local doctor’s list, they have closed their list due to capacity issues.
Even when patients are members of a practice, they sometimes have to wait several days if not weeks to see a GP. There is severe pressure on capacity in general practice.
McCauley said the capacity issues in many areas stem back to Fempi cuts, which were introduced during the recession. A deal to reverse the cutbacks was agreed earlier this year.
McCauley said these cuts left general practice “threadbare”, noting that many GPs were unable to hire an assistant or other staff during the recession.
The IMO has said about one in every four GPs plan to retire in the next five years, rising to almost four in 10 in Monaghan. Many of the doctors set to retire in the coming years have no one to replace them, particularly in rural areas.
If Fempi cuts didn’t happen, GPs would have taken on assistants years ago and they would be asked to become a partner at this stage, but people couldn’t afford to do that at the time.
“When older GPs retire there is no one to replace them … There is a demographic timebomb in certain counties, for example Monaghan. Rural general practice has a significant manpower issue, capacity issues are more notable there,” McCauley, who works in Co Donegal, said.
He added that emigration has also played a role, with many young GPs leaving Ireland to work abroad, stating: “Because of the state of general practice, young doctors were not entering the field and those who were were leaving.”
‘Short-term political gain’
“The reversal of Fempi measures will lead to some stability, but there have been 10 years of general practice being decimated with cuts and we now have to recover from that. The capacity issue has not and will not be solved overnight,” McCauley warned.
“Decisions that are made for short-term political gain can have a medium to long-term negative impact on the actual service.
“When discussing the concept of extending medical cards, there has to be an understanding about capacity issues, manpower and infrastructure. These have to be taken into consideration when making such a decision.”
McCauley said the IMO would prefer that any extension of free GP care focuses on people who cannot afford to attend a doctor, rather than particular age cohorts.
“Rolling it out to all under-eights catches people who can already afford to pay,” he noted.
“Expanding free GP access to any specific age cohort would not be our preferred route because there are limited resources available. Any expansion should focus on getting the most health value. In terms of eligibility the focus should be on people who cannot afford to see GPs, those are the people we worry about.”
The Department of Health had not replied to a request for comment at the time of publication.
During the week, Health Minister Simon Harris welcomed the extension of free GP care to under-eights, noting that expanding eligibility for primary care services is in line with the provisions in Sláintecare – a plan which seeks to improve Ireland’s health service over the next decade.
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