FORTY-five family doctors claim that GP services in Ireland are on a "track to destruction" because of successive government cuts to primary care funding, leading directly to a reduction in doctors and nurses available to see patients.
They say GPs' surgeries are downsizing and some will close, particularly in rural and inner city areas hit hardest by the cuts. The rural GP will disappear like the rural post-office and garda station.
In a letter to this newspaper written by Kilkenny GP Dr Eluned Lawlor and 44 other GPs, the doctors said successive governments had not only stopped the promised investment in primary care, but reversed it.
They said the GPs had "borrowed to build or upgrade" their surgeries on foot of the Primary Care Strategy' launched in 2001, designed to move patient care away from the expensive and 'creaking' hospital system into the community.
"We attended weekend and evening courses to improve our knowledge on health promotion and the management of chronic diseases like diabetes and heart disease.
"We trained in minor surgery and newer family planning methods. We were promised a new contract where this added work would be recognised and our practices resourced appropriately, so we took on work from hospitals and wrote letters so that our sicker patients with diabetes, arthritis and cancer also got medical cards.
"We encouraged these patients to come more often to monitor their care and prevent complications despite the fact that as a result of a contract negotiated 30 years ago, our practices only received funding to cover one or two visits a year rather than the 20 or more that some now needed."
The GPs claim that with the onset of recession, successive governments "not only stopped the promised investment in primary care, they reversed it, most recently making three successive cuts to its funding (up to 35 per cent) in as many years.
"At the same time, the increase in both physical and psychological ill-health in the population, unplanned transfer of care from the hospitals and reductions in both doctor and nursing levels have made our surgeries ever busier.
"The private and online companies have been quick to come in and cherry-pick the more straightforward work like pill checks and health screening during the daylight hours, leaving us struggling to provide the same 24/7 service to our increasingly less well-off, sick and elderly patient populations.
"We have paperwork mountains as we are inundated with requests for letters in support of medical cards as patients fear that they will lose them or have them replaced by GP visit cards which don't cover medications, public health nursing etc.
"We have to write letters for cancer patients stating their disease is 'terminal' and make phone calls for our elderly, sometimes confused patients who didn't reply to the review letter as they thought their plastic card was 'valid until 2020'.
"We fear that our surgeries will become even busier if the planned introduction of free medical care for the under sixes goes ahead. We can deal with a runny nose or a sore throat in five minutes but where do we find the time to deal with the more time-consuming heart attack, possible cancer or suicidal teenager?
"As has already happened in the UK, people won't be able to get appointments, let alone have time with us and some will end up spending hours in the already overcrowded emergency departments, getting sicker and receiving less efficient and more expensive care.
"Our older colleagues are taking early retirement, our younger ones leaving to work abroad where primary care is still valued. Those of us who stay, face burn-out and ill health from trying to help too many patients in one day, which is ultimately unsafe for both patient and doctor," they said. "It is our patients, particularly the most vulnerable who will ultimately pay the price for the continued systematic dismantling of General Practice in Ireland."
The letter was signed by Dr Eluned Lawlor, Kilkenny; Dr Joe Gallagher, Meath; Dr David Hanlon, Kildare; Dr Michelle O'Connor, Limerick; Dr John McCrohan, Mayo; Dr Martina Cogan, Roscommon; Dr Anne Cronin Good, Cork; Dr Grainne Pinaqui, Wexford; Dr Mary Roycroft, Cork; Dr Lucia Gannon, Tipperary; Dr Gary Stack, Kerry; Dr Jason McMahon, Limerick; Dr David Hanlon, Kildare; Dr Emmet Kerin, Limerick; Dr David Lane, Cork; Dr Liam Meagher, Killenaule; Dr John Casey, Connemara; Dr Illona Duffy, Monaghan; Dr Emer O Reilly, Dublin; Dr Paddy Halligan, Cavan; Dr Ken Devlin, Donegal; Dr Helen O Neill, Meath; Dr Jacqueline Glisson, Cork; Dr David Bartlett, Offaly; Dr Seamus McMenemin, Meath; Dr Richard Joyce, Galway; Dr Joe McAuliffe, Cork; Dr Darragh O Neill, Louth; Dr Seamus Clarke, Monaghan; Dr Emmet Kerin. Limerick; Dr Fergus Muredach, Cavan; Dr Mary Gray, Limerick; Dr Patrick Meagher, Galway; Dr Michael McConville, Cavan; Dr Mary Roycroft, Cork; Dr David Ross, Galway; Dr Alan Moran, Drogheda; Dr Gavin Maguire, Cork; Dr Siofra Nic an Bhreithiun, Donegal; Dr Fergal Hanlon, Kildare; Dr John McCormack, Galway; Dr Derek O Connell, Cork; Dr Declan Scanlon, Offaly; Dr Peter Wahlrab, Meath; Dr Aisling O'Carroll, Kildare.