THE PUBLIC is overusing the free GP visit scheme according to a County Limerick doctor who says she has seen several children under the age of two, at least 30 or more times outside of their normal vaccination and developmental checks.
This in turn is putting huge strain on the healthcare system and GPs in Limerick and around the country.
That is according to an open letter sent to Oireachtas Health Committee Chairman Dr Michael Harty and a number of TDs in Limerick and Kerry by Newcastle West family doctor Michelle O’Connor who stated that Government needs to heed the recommendations of the Slaintecare review which highlights the overuse of free GP visits.
Dr O’Connor is asking that TDs be made aware of a number of issues faced by GPs in Limerick and Kerry face during a a Dáil debate on the issue.
“Since the implementation of the free GP care for children under six, attendance of such children at my practice has increased by 40 per cent. This has also been reflected in the Shannondoc out-of hours service and I have several children under two who have attended more than 30 times in the first year of life, outside of vaccinations and developmental checks.
“This illustrates that people do not appreciate that which is free and instead overuse it. This has resulted in elderly people being unable to access the GP when they need to be seen and increased the number of people needing admission to hospital”.
Referring to the opening of the new accident and emergency department at the University Hospital Limerick (UHL), Dr O’Connor said it was “two year late” and on a recent visit there, she noted that although it is three times the size of the previous department, it was full of trolleys only 19 hours after being opened.
“There are 46 GPs in the West Limerick Shannondoc area and at least 11of them will be retiring in the next five years with no GPs to replace them.
“We currently struggle to find locums to cover holidays and have zero chance of finding anyone in case of illness or other emergency. Working as a rural GP is not attractive to them, she added.
The Newcastle West GP said that reversing Government austerity cuts should be a priority.
“General practice was hit with 38 per cent cut in funding which was greater than any other group. That was not to our wages but to the gross amount coming into our surgeries out of which we have to pay mortgages/rent, staff, professional indemnity, courses and conferences
“Many more patients became eligible for medical cards due to unemployment, as well as the introduction of the under-6 card and over-70 free doctor visit cards. This dramatically cut our private income as well,” she explained.
Calling for a funding increase in primary care, Dr O’Connor added that a new General Medical Services (GMS) contract for GPs should also be introduced as the existing contract was more than 40 years old.
“If hospitals are to have any hope of tackling the trolley crisis, we need to increase funding to home help, to carers and to nursing homes so that vulnerable people have somewhere safe to go on discharge.
“If we are to keep people out of hospitals, we need more access to occupational therapy, respite care and physiotherapy as there is a current wait of three years in Newcastle West.
Echoing the point on cover for rural GPs, Fianna Fáil TD Niall Collins said that a number of villages and towns in County Limerick were experiencing difficulties accessing locums.
“Also linked to this is the absence of a GP in Kilfinane to cover for the local doctor who is off work due to a serious accident. She can’t get a locum and people have to travel to Charleville to see a GP,” he explained.
Deputy Collins aired the issue recently and said he would be doing so again.
Dr O’Connor’s full letter as sent to Limerick and Kerry TDs and GPs in both counties;
Dr Michael Harty TD
Richmond Medical Centre
As you may be aware the all-party Oireachtas Committee on the future of Heathcare/Slaintecare Report recommendations are up for debate in the Dáil before the summer recess. We GPs would greatly appreciate your support in bringing the following to the attention of your colleagues before and/or during the debate.
1. Since the implementation of the free GP care for children under 6, attendance of such children at my practice has increased by 40%. This increase has also been reflected in the local out-of hours service, Shannondoc. Indeed I have several children under 2 attending me who have attended 30+ times in the first year of life, outside of vaccinations and developmental checks. This illustrates that people do not appreciate that which is free and instead overuse it. This has resulted in elderly genuinely unwell people being unable to access the GP when they genuinely need to be seen which has increased the number of people needing admission to hospital as they are seen later in their illness.
2. The new Accident and Emergency department in University Hospital Limerick opened on Monday 29th May (2 years late). I happened to be attending for a sexual assault and decided to have a look around. The new area is 3 times the size of the existing A&E and was already, 19 hours after opening, at 3am, full of trolleys. This is partly because of the problem detailed above and partly due to a lack of beds in the hospital itself.
3. There are 46 GPs in our West Limerick Shannondoc area. Of those 46, at least 11 will be retiring in the next 5 years. There are NO GPs to replace them. We currently struggle to find locums to cover holidays and have zero chance of finding anyone in case of illness or other emergency. My partner retired 2 years ago and I have been unable to find an assistant. This is for the following reasons:
• Young GPs now qualifying do not see Ireland as a viable prospect to run a business and are emigrating in their droves.
• Those who stay can pick and choose the jobs they want as there is such a shortage
• Due to the demand they can afford to work in cities where they have the back-up of a hospital nearby, where they don’t have to do out of hours work or house calls, where they can work as employees with all of the rights and none of the responsibilities of running a business.
• Rural GP is not attractive to them.
General practice needs your help. Put simply, if this continues, when you are older and need care, there will be no doctors to care for you.
One of the first things that needs to be addressed (now that it is being addressed with all other parties affected) is the reversal of the FEMPI cuts. GP was hit with 38% cut in funding over 3 years which was greater than any other group. That cut in funding was not to our wages but to the gross money coming into our surgeries out of which we have to pay mortgages/rent, staff, professional indemnity and for all the courses and conferences that are obligatory for us to maintain our medical registration.
At the same time as the FEMPI cuts, many more patients became eligible for medical cards due to unemployment, then you had the under-6 card and the over-70 card. This dramatically cut our private income also.
We cannot continue to provide the level of service that we have done for the last 40 years, plus take on all of the extra work that Slaintecare has suggested without funding and more doctors, and we will not get more doctors without the funding to make it attractive for them to stay.
The other thing that needs to be addressed with urgency is a new contract for GMS GPs. Our contract is over 40 years old and is completely unfit for purpose. Medicine and demand for care has changed dramatically in that 40 years and the new contract needs to reflect this. All parties affected, IMO, NAGP etc need to be at the table for that negotiation (not consultation) process. We were supposed to have a new contract by July 2015, 2 years later, there appears to have been little progress.
Thirdly funding in general needs to be increased to Primary Care. If we are to appropriately manage chronic illness (which incidentally is not part of our current contract), we need more staff and more money to do so, to purchase equipment and, hopefully if they can be found, hire extra doctors to help. If hospitals are to have any hope of lessening the trolley crisis, we need to increase funding to home help, to carers and to nursing homes so that vulnerable people have somewhere safe to go on discharge. If we are to keep people out of hospitals, we need more access to physiotherapy (current wait 3 years in Newcastle West, we have been advised to stop referring), to occupational therapy and to respite care. With an elderly population there is increased demand for house calls for which there is NO remuneration during surgery hours and it makes it financially unviable to do them. Multiple minor surgeries and other procedures such as contraception are carried out in GP and cost up to 10 times less when done in GP as opposed to in hospital but we don’t have the time (due to lack of doctors and abuse of the service) or the funds to perform them.
Lastly, with respect to “free” healthcare for all, I used to be in favour. But having seen the effects of the Under 6 card, I can no longer support it. I believe, as do most of my colleagues, that there should be a maximum number of “free” visits and/or a small charge for each visit so that people only attend when really necessary.
General practitioners are at the heart of the healthcare system, completing over 25 million consultations every year (95% of patient contact). The Irish public values their family doctor and wants their GP to be at the heart of their local community. However, we are at a crossroads – unless the recommendations above are implemented, we will never fix our healthcare system. This is our chance, and your chance, to help do that.
Michelle O’Connor MB, MICGP.
Cc All TDs in Limerick and Kerry