General Practice at Breaking point
Over the past three years, €160 million has been taken from general practice, equating to an average of a 76% per cent reduction of funding in income to individual practices.As a result of the latest round of cuts announced in July, many GP's say their services are now at breaking pointing and they predict serious difficulties in coping with the day-to-day running of their practices, particularly in the autumn/winter.
Reality of cuts on the ground
Gross income has been reducing since 2009 while at the same time there has been a huge reduction in private patients, but overheads – medical indemnity insurance, heat, electricity, staff costs etc – have gone up.
“People assume GP's are all very well off; they have no idea what’s going on.
Current rate of pay for medical card patients in Euros/month is :-
Males Females
Age group age 0-5 6.22 6.06
Aged 5-15 3.61 3.65
Aged 16-44 4.61 7.53
Aged 45-64 10.31 10.11
Aged 65-69 9.69 10.81
70+ 23.36 23.36
This is a flat rate of pay irrespective of how many times the patient is seen per month.
After paying staff, insurance, lighting , buying medications, equipment and paying tax, there is very little left. Many GP's have had to let staff go, reduce staff salaries, reduce staff hours or take second jobs to keep their practices afloat.
In desperation to save General practice ,the National Association of General Practitioners have launched a nationwide Crisis Campaign.
The campaign is calling on the Minister of Health to reverse the cutbacks which are having a detrimental effect on the health of the Irish people.
The purpose of the emergency campaign is to shed light on the impact of the Department of Health’s recent cutbacks. The National Association of General Practitioners predicts that the Department’s current cut will have an enormous impact on general practice, with longer waiting lists, no home visits and changes in fee structures.
Reality of cuts on the ground
Gross income has been reducing since 2009 while at the same time there has been a huge reduction in private patients, but overheads – medical indemnity insurance, heat, electricity, staff costs etc – have gone up.
“People assume GP's are all very well off; they have no idea what’s going on.
Current rate of pay for medical card patients in Euros/month is :-
Males Females
Age group age 0-5 6.22 6.06
Aged 5-15 3.61 3.65
Aged 16-44 4.61 7.53
Aged 45-64 10.31 10.11
Aged 65-69 9.69 10.81
70+ 23.36 23.36
This is a flat rate of pay irrespective of how many times the patient is seen per month.
After paying staff, insurance, lighting , buying medications, equipment and paying tax, there is very little left. Many GP's have had to let staff go, reduce staff salaries, reduce staff hours or take second jobs to keep their practices afloat.
In desperation to save General practice ,the National Association of General Practitioners have launched a nationwide Crisis Campaign.
The campaign is calling on the Minister of Health to reverse the cutbacks which are having a detrimental effect on the health of the Irish people.
The purpose of the emergency campaign is to shed light on the impact of the Department of Health’s recent cutbacks. The National Association of General Practitioners predicts that the Department’s current cut will have an enormous impact on general practice, with longer waiting lists, no home visits and changes in fee structures.
Links to articles on the cuts
Why General Practice in Ireland got sick!
A personal perspective by a Kilkenny GP.
The Department of Health launched the 'Primary Care Strategy in 2001'. It stated ‘Primary care needs to become the central focus of the health service as it leads to better outcomes, better health status and better cost-effectiveness. There will be significantly enhanced commitment to the funding and development of primary care'. GPs believed these promises. They borrowed to buy, build or upgrade their surgeries; to invest in computers, spirometers, ECG machines, and defibrillators. They attended evening and weekend courses to improve their knowledge on the management of chronic diseases like diabetes and heart disease. They trained in minor surgery and the newer family planning methods. They wanted to provide the best care possible for their patients, locally in their own surgeries rather than send them to the more expensive and often less efficient hospitals.
They were promised a new contract where this added work would be recognised and their practices resourced appropriately so they took on work from secondary care and filled in the applications for medical cards on medical grounds (discretionary medical cards) so that their sicker patients with heart disease, diabetes, arthritis and cancer now got medical cards too. Unfortunately, as the result of a GP contract negotiated in the 1970's designed to cover a third of a mainly healthy population, practices still only received sufficient funding to cover one or two visits a year rather than the fifty that some of these newer patients needed. In addition, they never received funding to pay for the frequent blood tests, blood pressure monitoring, and check-ups needed to manage these conditions.
With the onset of the recession, despite international evidence to the contrary (World Health report 2008. Primary Care- Now more than ever) the government not only completely reversed its investment in primary care but also made 3 successive cuts to the funding, totalling 35% over a 3 year period. This reduced it to < 3% of the total health budget in comparison to 9% in the UK. At the same time, private patients lost their jobs or became chronically sick, also got medical cards and visited their GPs more often.
The private and online companies came in and cherry picked the more straightforward work like pill checks and health screening and left the GPs (still heavily in debt to the banks as a result of investing in their practices) struggling to look after the poor, the sick and the elderly.
The Minister for Health still went around talking about 'free health care', most recently for the under 5's but as the Competition Authority had taken the GP body, the IMO to court for trying to advise its members, there was no communication at all with the people who were supposed to provide this service. At the same time, some of the patients most at need of free medical care such as the elderly and those with cancer seemed to be having more difficulty getting a medical card.
The GPs tried to tell their patients what was happening via the media but were labelled as ‘money grabbing fat cats’ particularly when in order to try and keep their staff employed and their surgeries open they were forced to introduce small fees for services for which they were not paid. The HSE fuelled the 'anti GP' movement by continuing to publish gross payments to GP unlike the NHS figures which deducted 60% to allow for practice running costs.
In the end, as had already happened in the UK, the surgeries became overwhelmed. Patients could no longer get in to see their GP, let alone have time with them, their care suffered and they ended up back in the already overcrowded A & E departments in the hospitals, receiving less efficient and more expensive care while the taxpayer footed the bill. The older GPs took early retirement due to burn out and ill health from trying to see 70 patients a day and the surgeries started downsizing and ultimately started closing, particularly in the rural and inner city areas.
By the time the Government realised what it had done it was too late. The older, more experienced GPs were no longer working and the younger GPs, after 10 years training had become disillusioned with the future of General Practice in Ireland and gone abroad to countries like Canada where primary care was still valued.
Ultimately, the patients were the people who paid the price for the government's swift and systematic destruction of General Practice in Ireland.
Sad but true!
Dr Eluned Lawlor, GP, Kilkenny City.
A personal perspective by a Kilkenny GP.
The Department of Health launched the 'Primary Care Strategy in 2001'. It stated ‘Primary care needs to become the central focus of the health service as it leads to better outcomes, better health status and better cost-effectiveness. There will be significantly enhanced commitment to the funding and development of primary care'. GPs believed these promises. They borrowed to buy, build or upgrade their surgeries; to invest in computers, spirometers, ECG machines, and defibrillators. They attended evening and weekend courses to improve their knowledge on the management of chronic diseases like diabetes and heart disease. They trained in minor surgery and the newer family planning methods. They wanted to provide the best care possible for their patients, locally in their own surgeries rather than send them to the more expensive and often less efficient hospitals.
They were promised a new contract where this added work would be recognised and their practices resourced appropriately so they took on work from secondary care and filled in the applications for medical cards on medical grounds (discretionary medical cards) so that their sicker patients with heart disease, diabetes, arthritis and cancer now got medical cards too. Unfortunately, as the result of a GP contract negotiated in the 1970's designed to cover a third of a mainly healthy population, practices still only received sufficient funding to cover one or two visits a year rather than the fifty that some of these newer patients needed. In addition, they never received funding to pay for the frequent blood tests, blood pressure monitoring, and check-ups needed to manage these conditions.
With the onset of the recession, despite international evidence to the contrary (World Health report 2008. Primary Care- Now more than ever) the government not only completely reversed its investment in primary care but also made 3 successive cuts to the funding, totalling 35% over a 3 year period. This reduced it to < 3% of the total health budget in comparison to 9% in the UK. At the same time, private patients lost their jobs or became chronically sick, also got medical cards and visited their GPs more often.
The private and online companies came in and cherry picked the more straightforward work like pill checks and health screening and left the GPs (still heavily in debt to the banks as a result of investing in their practices) struggling to look after the poor, the sick and the elderly.
The Minister for Health still went around talking about 'free health care', most recently for the under 5's but as the Competition Authority had taken the GP body, the IMO to court for trying to advise its members, there was no communication at all with the people who were supposed to provide this service. At the same time, some of the patients most at need of free medical care such as the elderly and those with cancer seemed to be having more difficulty getting a medical card.
The GPs tried to tell their patients what was happening via the media but were labelled as ‘money grabbing fat cats’ particularly when in order to try and keep their staff employed and their surgeries open they were forced to introduce small fees for services for which they were not paid. The HSE fuelled the 'anti GP' movement by continuing to publish gross payments to GP unlike the NHS figures which deducted 60% to allow for practice running costs.
In the end, as had already happened in the UK, the surgeries became overwhelmed. Patients could no longer get in to see their GP, let alone have time with them, their care suffered and they ended up back in the already overcrowded A & E departments in the hospitals, receiving less efficient and more expensive care while the taxpayer footed the bill. The older GPs took early retirement due to burn out and ill health from trying to see 70 patients a day and the surgeries started downsizing and ultimately started closing, particularly in the rural and inner city areas.
By the time the Government realised what it had done it was too late. The older, more experienced GPs were no longer working and the younger GPs, after 10 years training had become disillusioned with the future of General Practice in Ireland and gone abroad to countries like Canada where primary care was still valued.
Ultimately, the patients were the people who paid the price for the government's swift and systematic destruction of General Practice in Ireland.
Sad but true!
Dr Eluned Lawlor, GP, Kilkenny City.
