Wednesday 15 August 2018

Comment: GPs are now expected to work even harder - but we're not being treated fairly on Fempi

Photo posed
Photo posed

Dr Catherine O'Donohoe

LAST month I met a pregnant woman in New Ross who told me how she and her family were unable to register with a GP locally.

She was still with her previous GP, more than 90km away where she had lived prior to moving to the area. She was worried about how she would manage after the baby was born and in due course needing its childhood immunisations.

I run a practice 20km outside of New Ross but, due to the volume of work, was unable to offer to register her and her family.

The weekend before I met the lady, I had attended the AGM of the National Association of General Practitioners (NAGP). The topic on many GPs' minds there was that of Fempi reversal. Fempi (Financial Emergency Measures in the Public Interest) was the series of wide-ranging cuts that were introduced by Irish governments from 2009-'13 in order to stabilise public finances in the aftermath of the banking crisis.

The cuts sustained by general practitioners in Ireland were among the highest sustained by any group of workers in the State - more than 35pc before tax, and before the cost of running a business was taken into account.

Last November, Finance Minister Paschal Donohoe stated: "Our teachers, nurses, gardaí and other public servants and their retired counterparts are deserving of the pay and pension restoration set out in this Bill, particularly after such a long period of wage restraint and reductions. There is also a legal entitlement to that restoration, since the Fempi Acts, which significantly reduced their pay and pension entitlements, were predicated on a financial emergency from which we have now, thankfully, emerged".

However, he proceeded to say that there was a different approach to be taken for another grouping which includes GPs: "Part 5 places certain provisions of the Fempi legislation on a permanent, non-emergency footing. These provisions relate to the power to vary the fees paid to contractors, mainly health professionals, for services and goods rendered."

At the NAGP AGM, the ministerial address was given by Jim Daly TD, Minister for Mental Health and Older People.

His statement that "Fempi will be reversed ... but it will be linked to service improvements across general practice..." was met with dismay, upset and anger among attendees and many other GPs around the country who were following the conference.

There is increasing awareness of the impending tsunami of GP retirements in the next few years

The cuts sustained by general practitioners in Ireland were among the highest sustained by any group of workers in the State. Photo posed How much harder can GPs be expected to work at present? There has been significant coverage in the media, and also on social media, regarding the difficulties currently faced by people trying to register with GPs in many areas, including but not limited to Carlow, Monaghan, Kildare, Carrickmacross, Leitrim, Naas, Clare, Bray and Cork. There is increasing awareness of the impending tsunami of GP retirements nationally in the next few years. Yet, GPs are told to work harder. There is a serious disconnect between our political decision-makers and the experience at grassroots of both GPs and the general population.

Our political leaders do not seem to understand that while dealing with the cuts sustained under Fempi from 2009-'13, we have also dealt with increasing chronic disease management, increasing difficulty finding locum cover, increased tax and PRSI payments for locum doctor services, documenting 62 hours study every year to maintain our medical registration, the introduction of the Under Six Doctor Visit Card entitlement, and so on.

What if what Chris Goodey, CEO of NAGP, said at the AGM is true: "One of the things I've been noticing over the last year is massive burnout of GPs."

What if GPs can't actually work any harder? What if more and more GP practices all around the country become unable to take on more patients due to the risk of unsafe workloads? What can we expect the trolley situation to be like next winter if GPs are unable to provide care for new nursing home residents due to current workloads?

In six months' time, how long will patients have to wait for an appointment to see their doctor ... if they are registered with a practice?

What will our A&E departments be like if patients cannot access GP services?

It is illegal for GPs to strike, under Competition Authority rules and legislation. What else can GPs do to convince our political leaders of the dire need for reversal of Fempi? The possibility of GPs running for election is now being openly discussed online.

I am a member of Fine Gael and informed the Wexford constituency convention before Christmas that if an election had been called, I would likely have resigned my membership to either run myself as a candidate or support other colleagues running, due to our concerns about the ongoing and deepening crisis in general practice.

How many GPs would be needed on the Dáil floor to effect Fempi reversal for general practice? What a waste of GPs and their skills should they feel they have no other option but to run for parliamentary office.

Why is it that the Finance Minister can state that some groupings (mainly unionised State employees who can strike) have a legal entitlement to Fempi restoration but others including GPs don't? Is it because GPs can't strike and hence it is easier politically to make such a distinction? If some groupings are legally entitled to restoration, is it illegal, discriminatory and indeed unethical to treat others, who were subjected to the more severe effects of Fempi, differently?

Fempi is the elephant in the room for Irish general practice. It is pointless telling us that we need to work harder. Our hands are tied by Fempi and Fempi must be reversed before we can even begin to consider taking on any extra work.

Dr Catherine O’Donohoe is a single-handed rural GP in Co Wexford

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