Tuesday 16 January 2018

Free GP care for under-12s is a tonic, but can doctors cope?

Minister For Health Leo Varadkar
Minister For Health Leo Varadkar
Eilish O'Regan

Eilish O'Regan

Is it enough to persuade GPs to push the 'send' button in those online ads trying to entice them from rain-lashed Ireland to sun-drenched and surf-washed Australia?

This time next year they will be asked to take on another 200,000 children under 12 for free visits in return for a State fee yet to be revealed.

The Budget Day announcement about the further extension of free GP care, following its introduction for under-sixes and over-70s over the summer, sparked the inevitable negative reaction from family doctors who have long complained of feeling disillusioned, undervalued and underpaid after years of fee cuts.

Health Minister Leo Varadkar was quick to repeat yesterday that the phasing in of free GP care was well signalled. But the under-12s measure would not happen until a full-scale new contract for GPs providing State-funded services had been agreed, he said.

Of course the doctors are talking tough - and that is predictable given they are in negotiating mode.

The reality is that this overhaul of their 40-year-old contract - which is at the centre of current talks - is their best chance to clamber out of the crisis of workload, morale and money many of them are in.

It will have to include a rise in capitation fees for medical card and GP card patients, more practice supports to allow them hire nurses, doctors and invest in equipment and technology.

There needs to be incentives for GPs in rural and disadvantaged urban areas.

For all their grievances, there is still a lot in a good State contract to sell it to GPs. They are unique among self-employed professionals in that they get a public pension, based on their number of medical card patients.

They are in a good bargaining position because of the unrelenting and dispiriting pressure on hospitals - and the need to divert more patients with ongoing illness to GP care.

And the Government is clearly on a winner when it comes to offering the public free GP care.

As of yesterday, some 201,072 of the 270,000 eligible under-sixes were signed up for the perk.

And 42,554 over-70s have registered for free visits - around 2,000 more than estimated. Among GPs, 2,411 of 2,954 have signed the contract to provide free care to under-sixes. They are getting a yearly capitation fee of €125 per child, much higher than what was previously on offer.

This winter will be a test of what kind of workload these 243,620 former private patients will bring to the nation's surgeries.

It is certain to put more pressure on GP co-ops providing out-of-hours services.

It will also be important to measure what impact it is having on other patients who have serious illnesses and need more of their doctor's time. All of this should feed into the crucial new contract talks.

The next government can expect the bill to deliver on the new contract to be high. That headache will fall to whoever is Minister for Health this time next year. In the meantime, the under-12s pledge will loom large in the upcoming pre-election manifestos.

Irish Independent

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