Monday 11 November 2019

Angry GPs warn Varadkar general practice is 'haemorrhaging'

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

Eilish O'Regan

Health Minister Leo Varadkar ended up getting a standing ovation from roomful of GPs today - despite telling doctors he would not work for some of the fees they are getting.

Some angry GPs also warned him that general practice is haemorrhaging.

Mr Varadkar spent much of the day mingling with doctors at the AGM of the Irish Medical Organisation (IMO) in Kilkenny in a bid to appeal to GPs to sign up for the controversial contract offering free visits to under-sixes.

When he was told that many GPs have given up stitching patients - because they only get €7 for the service - he admitted he would not do the job for that sum.

However he said the under sixes measure - worth €67m to GPs - is just a first step in more investment in GP care and the austerity cuts of over €100m imposed in their State fees will be restored in the coming years.

But he cautioned this will come at a price and there will have to be changes to the kind of services and work practices of doctors in return.

Most of the gathering of around 150 of the 2,500 at the meeting expressed strong reservations about the move but conceded they are likely to be left with little choice but to sign up.

It will mean that around 270,000 under-sixes whose parents currently pay around €60 for a GP visit will visit their doctor free from early to mid-July.

Dr Niall Macnamara, a GP in Waterford, told the minister that general practice is haemorrhaging and the extra funding for the under-sixes will just "slow the blood loss."

He said bluntly:"We need to get general practice out of intensive care."

Dr  Oliver White, a Mayo GP, said the decision to end the scheme where GPs were allowed keep some of the savings they made in their drugs dispensing was a major financial blow and affected jobs.

Under the proposed under-sixes scheme GPs who sign up will get a €125 a year capitation fee per child, regardless of the number of visits.They have to do a weight and height check at age two and five yaers.

They will get extra payments for diagnosing asthma and providing checks.

The doctors are also in line for a €100 annual fee for providing two reviews of adult diabetics who are covered by the medical card and GP visit scheme.

However, doctors are worried they will not be able to cope with the extra workload at a time when growing numbers are having to introduce appointments for patients.

Mr Varadkar told the meeting:"Education for children and free travel for senior citizens is not means-tested and healthcare should not be either. Means-tests and sickness test might appear fair on paper. In reality, they create many injustices and anomalies. There are always people just above the financial threshold no matter where you set it and there are always people who won't satisfy the sickness test who are told to come back and apply again when you are sicker to submit more reports, more documents, bills and payslips. Let's start putting a stop to all of that at least for children and senior citizens.

"I know a lot of GPs are disgruntled after years of cutbacks and I know it won't be easy to convince everyone to sign up, but you are doing the right thing for general practice and for patients, and history will remember you for it. This is, after all, the widest extension in eligibility in health care service since Erskine Childers brought in the first GMS contract almost half a century ago and wider than the Mother and Child Scheme before that.

"But this is just phase one. I look forward to the commencement of talks soon on the new GP contract."This will allow for further expansion of GP care without fees including other school-going children in accordance with Government policy, he said.

"But I also want to see further progress on chronic disease management, warfarin clinics, a revised schedule of STCs and a medicines management programme. In short, I want GPs to be able to do all that we are trained to do.

"With the encouragement of the IMO and the ICGP, I pushed hard to include diabetes in this year's reforms and worked to ensure that any wellness checks would be simple and evidence-based. I want these to be the precursor to a new chronic disease management programme in the next contract covering the most common chronic diseases as a bundle - asthma, COPD, heart disease, diabetes and hypertension - maybe others."

He promised he will will press ahead this year in expanding GP access to ultrasound scans and a pilot where family doctors can do minor surgery."If successful, they will be mainstreamed in 2016 and 2017. I know that many GPs have difficulties on an administrative level with PCRS.

"My mother, who was also practice nurse and practice manager to my father, often told me that she could never quite work out what we were paid for and what we were not", He has now delegated Dr Liam Twomey the Fine Gael TD who is also a GP to talks to other family doctors and the medical card division of the HSE" to see if we can iron out some of the ongoing difficulties. I am confident we can."

He said he has genera practice in his DNA."I grew up over the shop and trained and worked as a GP Registrar. I believe in General Practice and I believe in a system of primary care lead by GPs. And I hope you believe me when I say it."

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