Wednesday 22 November 2017

The spiralling costs of out-of-hours doctors

Breda Heffernan and Sam Griffin

Parents could still face hefty GP bills - paying €100 or more for a home visit - even after free GP care for the under-sixes is introduced this summer.

This is because many out-of-hours GP service providers have yet to indicate if all their members will provide free care for under-sixes.

A number of service providers confirmed to the Irish Independent they will be offering free out-of-hours GP care to the under-sixes when the change comes into force from July.

These include D-Doc, which operates in north Dublin city and county, NOW Doc in the north west and Care Doc, which operates in the south east of the country.

However, other providers said they have yet to take a decision.

After the new scheme is introduced, parents won't have to pay to bring their child to see the doctor during normal surgery hours, provided the GP is signed up.

But there is great uncertainty over the charges if their child becomes sick overnight and the GP who attends has not signed up to the scheme.

Meanwhile, an Irish Independent survey found wide discrepancies for the cost of calling out a GP across the country.

While patients with medical cards are seen free of charge, private patients currently pay as much as €90 for an out-of-hours consultation with a GP in a treatment centre while a home visit can cost as much as €110.

There are around 2,500 GPs working in Ireland, with hundreds of these operating in co-ops to provide consultations with patients outside of normal surgery hours.

Arlene Fitzsimons, operations managers with NEDOC, which treats patients in counties Louth, Meath, Cavan and Monaghan, said it has yet to decide whether it will take part in the new under-sixes scheme.

"We haven't made a policy decision on it. It's not due to come in until July and pending 40pc uptake by GPs. If it's accepted by 40pc of GPs we will have to decide if it's going to be implemented. There may well be members of NEDOC that haven't accepted it.

"It's a very complex situation and one that we will have to wait and see what happens. But our board will be discussing it, to see what affect it has on the co-op."

She said that under the current GMS contract, doctors are paid €41.63 for an out-of-hours consultation with a medical card holder, regardless of whether they are seen in a treatment centre or at a home visit. A recent analysis by NEDOC found that home visits take on average 45 minutes and Ms Fitzsimons said €41.63 does not cover the cost of that.

Dr Mel Bates, a GP in Fairview, Dublin, and a member of D-Doc, said it will be providing free out-of-hours care for the under-sixes.

"We cover everyone who is currently covered by a medical card. Any private patient who registers with the under-sixes scheme will be free from the point of service. It's in our contract to look after people with medical cards," he explained.

However one doctor, who is part of a co-op in the south of the country and asked not to be named, said GPs are "terribly worried" about the implications of the under-sixes scheme.

"It's a very tough position - you're being asked to supply a resource when you don't know what the demand will be.

"The under-sixes, no one can price it because you can't quantify it. You don't know who's going to turn up in out-of-hours . . . It's like pinning a tail on a donkey, no one knows how much it's going to cost."

In the survey of prices, the most expensive was KDoc which charged €90 for a consultation at one of its centres and €110 for a home visit.

However the price fell if the patient was registered with one of KDoc's member GPs to €65 for a consultation and €85 for a home visit.

The cheapest provider was NOW DOC which charged as little as €50 for either a consultation or a home visit.

Across Dublin, private patients were typically charged €60 for a consultation and €80 for a home visit.

Elsewhere around the country, consultations generally cost €60, although there was a wide variation in the fees charged for home visits which ranged from €60 to as much as €100.

Irish Independent

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