Download GP care – there`s definitely no free lunch

From the Trenches
GP care – there’s
definitely no free lunch
Forum
Government proposals for free GP healthcare are unfair for some
and beneficial for others, writes Michael O’Brien
There is probably no truer saying than: “There’s no such
thing as a free lunch.” A recent consultation illustrated this
point to me nicely when a woman came into my surgery
for her usual six-monthly pill prescription. I told her that I
enjoy these consultations as they are normally routine and
easy. If I really tried, I could have the patient out the door
with her prescription in two minutes. But that’s not the way
I work. If she is going to be charged for a consultation, I
would like to offer her value for money.
This extra time with the patient allows me to inquire about
her general health and whether she has any concerns. At
the end of the consultation, I felt that she didn’t begrudge
me her E50-55 consultation charge. As
she was leaving, she commented that
she was looking forward to her “free”
GP care in a couple of years when she
would be saving herself between E100110 a year.
When I asked her what ‘free’ meant to
her, she stopped and for the first time
actually thought about it. I explained to
her that ‘free’ does not actually mean
‘free’ – that somebody is going to have
to pay for it via taxes, etc. I said that
she would probably be paying an extra
E300-400 a year in her own taxes to
look after the general medical needs of the rest of the
population.
Now she says that she would rather the situation stays the
same, whereby she pays her own way and does not have to
subsidise others who may be taking advantage of the ‘free’
care.
At this point, I am waiting for a response from our professional medical organisations with regard to educating the
general public about the proposed ‘free’ GP care.
One of the first objectives of this government is to offer
medical cards to those with long-term illnesses. At present,
these illnesses are clearly defined but do not include
chronic conditions such as asthma, chronic obstructive
pulmonary disease and ischaemic heart disease. Clearly,
there is a flaw in the limiting of long-term illnesses when
the biggest killer in this country, cardiovascular disease, is
not included on the government’s list.
If the government’s health aim is to reduce morbidity and
mortality, then it is missing the big picture by not including
cardiovascular disease as a long-term illness.
Next up for ‘free’ medical care are those that are on high-
tech medications. These drugs have revolutionised our
treatment of illnesses such as rheumatoid arthritis, ankylosing spondylitis, psoriasis and colitis. They are massively
expensive and prescriptions can only be initiated by consultants. I would question: should the diseases or severity
of them, and not the medication, be the overriding factor
in deciding who should get free GP care? Should a patient
with mild ankylosing spondylitis be entitled to free care over
a child with congenital heart disease?
What effect will ‘free’ GP care have on individuals? As my
earlier point suggests, some will be paying far in excess of
their normal medical requirements and others will do well
from it. It is generally accepted that if
medical care is free, then consultation
rates increase. This is apparent when we
compare visiting rates of public versus
private patients.
Will GPs be able to cope with the
increased demands on their service? Will
patients be able to access their doctor in
a timely manner when they are unwell?
If the English system is anything to go
by, people may end up waiting for three
days for the treatment of a sore throat!
What effect will ‘free’ GP care have on
me as a doctor? At present, I work in a
predominantly private practice. I actually like the fact that
patients know that they are going to have to pay for their
consultation and know its value.
At present, we are training top quality GPs to work in our
health system, but if the government plans to go ahead
with its current proposals there will be a need for a much
greater number of GPs. Currently, our GP training is about
four years long, so the government would need to drastically increase the number of vocational training positions
promptly.
We don’t want the panic situation that we saw in the
emergency departments where staff were severely underresourced and it was reported that some substandard
doctors were employed.
At least in hospitals, the staff were under supervision.
Who would supervise doctors in GP surgeries?
Let me finish with another saying: “If it ain’t broke then
don’t fix it!” Although, I do agree that some aspects of general practice need tweaking!
Michael O’Brien is in practice in Leopardstown, Co Dublin
FORUM December 2011 61
Trenches -GT/AH/NH4* 1
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