Tuesday 11 December 2018

The doctors swamped by free GP care for children

Study reveals huge differences in patient age

Stephen McMahon: Figures show variations in workload. Photo: Gareth Chaney Collins
Stephen McMahon: Figures show variations in workload. Photo: Gareth Chaney Collins
Maeve Sheehan

Maeve Sheehan

Family doctors in Dublin North Central see more public patients than anywhere else in the country, with an average of 1,217 patients for each GP, a new study shows.

GPs in the area have an average of 188 children aged six or under on free visit cards, compared with their colleagues in the more affluent suburbs of Dun Laoghaire/south Dublin, who see an average of 89. However, south Dublin doctors have the highest average numbers of over-70s on free GP visit cards. GPs in south-east Dublin - an area that stretches from Sandymount to Sandyford - have an average of 96 older patients on their lists, those in Dun Laoghaire have an average of 85 while those in north Dublin have 25.

The figures were compiled by the Irish Patients' Association (IPA) ahead of the next round of talks on a long-awaited new GP contract due to start in three weeks.

The analysis of General Medical Scheme figures for 2016 shows that more than one in 10 patients on a GP's list is a child aged six or under. According to IPA director Stephen McMahon, the figure reflects the concerns of doctors who say free GP visit cards are clogging up their surgeries.

The figures also highlight the need for financial supports for GPs to be weighted in areas where doctors see greater numbers of medical card patients with complex and multiple conditions.

"This is the first in a series of analytical pieces on primary care, as the State begins the process on one of its largest contracts that it will sign on behalf of its citizens. In advance of a new GP contract, we need to understand the variation of workload," Mr McMahon said

The new talks come against the backdrop of a chronic shortage of family doctors, rural areas left without any cover, and surgeries closed to new patients. The Irish Medical Organisation (IMO) and the National Association for General Practitioners (NAGP) claim a 38pc cut in fees and allowances and poor resourcing of primary care is driving the crisis. The Department of Health claims the cuts imposed during the financial emergency (FEMPI) are closer to 24pc.

Fianna Fail claims the Government is wrong. The scale of cuts was detailed in reply to a parliamentary question tabled by Fianna Fail TD Niall Collins. Three rounds of cuts in 2009, 2010 and 2013 included a 50pc cut to the capitation fee for patients in nursing homes; an 8pc cut to fees under the maternity and infant care scheme; a 15pc cut in fees under the Heartwatch scheme, along with a further 7.5 reduction in 2013; and an 8pc cut in leave cover, locum expenses, the rural practice allowance and other services.

Mr Collins said the scale of cuts "prove what GPs have been saying. That their fees and supports have been cut by almost 40 per cent, while the Government is trying to present it as though they have received a 24 per cent cut."

The Fempi cuts have become a flashpoint. The IMO and NAGP have called for their reversal, and NAGP chief executive Chris Goody has urged the Government to begin the process ahead of the contract talks, as a "goodwill gesture".

The HSE paid over €540m to GP practices and co-ops in 2016 in fees and allowances for services to patients under the medical card scheme. Doctors pay practice expenses, staff salaries and overheads out of the payments. Examples of current fees include a €982.81 once-off registration fee for 15 or more patients in the Heartwatch programme; €20,630.57-€37,822.72 in practice supports for nurses and secretaries; a €434.15 annual capitation fee for treating over-70s in nursing homes.

Sunday Independent

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