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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 11J30J11 10:30:30