Steal from the poor and give to the rich

Free GP Care for Under-6s

It is unethical and immoral to select children of high earners for free GP care over those on lower income, those with chronic illnesses and other vulnerable patients whose taxes are being used to fund it but who won't get free care themselves........

Free GP Care for Under-6s

Minister Reilly seems undeterred by the negative reaction to his plan to award 'free' GP care to all children under 6 in Ireland (regardless of their parents income or their ability to pay). This scheme has neither been detailed fully, resourced adequately nor has its implementation been discussed or negotiated with the GPs who are going to be responsible for its safe and effective delivery.

A new survey by the National Association of GPs (NAGP) produced yesterday, with a huge response of over 700 GPs, has found that only 3% of Irish GPs will 'definitely' sign up for a new as yet undetailed under-6s service:

Read the full article here as published in The Irish Times on 22 Jan 2014....

There aren't enough GP perspectives on this topic, so here's the slant from a young GP practice in Galway City centre, for what it's worth.....



It is unethical and immoral to select children of high earners for free GP care over those on lower income, those with chronic illnesses and other vulnerable patients whose taxes are being used to fund it but who won't get free care themselves.

As a GP, and a parent of a young child who is not eligible for a medical card under existing rules (but may get one this year anyway), I am appalled that scarce resources could be misdirected in this way and infuriated that medical cards are actively being taken away from patients in genuine need to fund this political stunt.

Those of us who object to our children getting a medical card over someone else with greater need can't even give it back as there is no facility to do this, nor can we offer to donate it to someone of greater need.

Imagine how it feels to have to explain to one of your patients with a chronic condition that their card is no longer valid while knowing that your own perfectly healthy 1 year old has just been given a medical card that he doesn't need.

Lack of Evidence

There is no medical evidence to support giving medical cards based on date of birth rather than income level or need. The Irish College of GPs have looked for this data from Government:

"The ICGP is calling on the Government to provide details of the reports or data that the Department of Health used to measure the health outcomes and benefits that universal medical cover for children aged five and under would deliver, and how that compares with the impact of withdrawing medical cover from the over 70's".

Click for full article.

Of course it would be great if we had free healthcare for everyone and could remove any financial barrier to attending the GP, but that simply can't happen without proper planning and coordination. Proper planning in this instance has to include negotiating with GPs and resourcing General Practice appropriately, as well as being aware of knock-on effects on other parts of the health service. It could involve huge tax hikes, or reallocating funds from the already struggling hospital sector, or involving insurance companies (who will make profits at your expense). It takes more than wishful thinking and a wave of the Ministers hand to make it so. Kieran Ryan, CEO of the ICGP says:

"It represents an excellent opportunity to look at how a high standard of care can be provided to under-fives, but planning, dialogue and inclusion of GPs and other stakeholders is required for it to work in practice."

Click for full article.

Impact on General Practice

General Practice in Ireland is at breaking point after a series of harsh and random cuts in recent years. GPs are small business owners, just like your local shop. We pay rent, bills, medical indemnity, as well as being responsible for employing appropriate medical and administrative staff to provide a good service to patients. The difference is that our biggest customer, the HSE, has drastically reduced what they are paying us, while expecting us to take on more work with no consideration for whether we can afford to or not. GP surgeries, like shops, will be forced to close if this continues.

The impact on General Practice of extending GP visit cards to a significant chunk of the population in an instant has NOT been assessed by the Government.

It's certainly the cheapest, fastest and easiest way for them to get a foot on the ladder of their promise of free GP care for all, which is why the Under 6's were chosen (they tried giving them to those with chronic illnesses but failed). But it has the capacity to damage General Practice beyond repair.

New research by the Irish Medical Organisation is helping to  highlight WHY the system cannot cope. Click here.

It warns: "demand for visits to GP services is likely to increase by 4 million visits a year (16%) if the Government extends free GP services to all as planned by 2016."

The research confirms that "public patients (Medical Cards / GP Visit Card holders) visit a GP on average almost 8 times a year (7.72) whereas private patients visit their GP on average just over 3 times a year (3.35)".

The Government seem to have based their move on patients visiting the GP 3 times per year (not 8). We're not sure where they got their figures from as there is no system in place to record daytime visits by GMS patients.

Fast-track to the collapse of the Irish Healthcare System

It's not just in the GP surgery that our patients will suffer.

At present, our Hospital system is on the verge of collapse, through a combination of mismanagement and lack of resources.

Irish GPs currently do about 24 million consultations every year according to the study referenced above..... at a cost of about 2% of the health budget.

We keep about 90-95% of those people out of hospital at present.

What happens when we refer just a few percent of that 24 million to A/E and OPD because we can't cope?! The hospital system will crumble. GPs have the capacity to prevent this catastrophe if resourced, but we also may have no choice but to cause it.

Dr Andrew Jordan, Chairman of the National Association of General Practioners agrees:

"€37 Million to fund the under 5 scheme is totally inadequate to provide the same quality of service that these children current enjoy. If the 280,000 children under six who do not have a medical card are given one, then there will be a huge increase in visits to GPs – thereby increasing the average workload of GPs - other patients will, of necessity - have to lose out or wait. If the GP service is overwhelmed, it will have a serious follow-on impact on the rest of the health service with disastrous results.

Click to read full article.

This issue is not just about providing 'free' GP care to Under 6's. We would all welcome any measure to help those in most need. That's what the medical card system was designed to do and what GPs signed up for.

This is nothing more than a political stunt and should be treated as such.

To requote Dr Darach Ó Ciardha from an earlier link...

"In the current economic climate, we have to assume that if the Government is taking over the burden of paying for these services from the individual, then the money to pay for the provision of these services is coming from somewhere else in the health system. If paying for this is coming from the medical card scheme, without that pot being increased considerably, then other vulnerable groups will be affected most. It would not be fair or reasonable that someone on a high salary, who can afford to pay for GP care for their child, would now get it for free, but that vulnerable people who need medical cards would lose them to pay for it."

Who will suffer because of this? The poor, sick and vulnerable. The ones just above the threshold for medical cards who still can't afford to see the GP.

How can we have any faith in a government who would steal from the poor and sick in our society to give to the young healthy and wealthy children.

Click here for Irish Medical Organisation updates


tags: Under 6's, Free GP Care, NAGP, IMO, Evidence Based Medicine


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