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Free GP Care for Under Sixes

Under a new scheme announced by the Irish Government on October 15 2013, free GP care will be made available to all children under six. When first mentioned by Finance Minister Michael Noonan during his Budget 2014 speech, it was declared that €37m would be allocated to provide free GP care for under 5s, but this has since been extended to cover under 6s.

 For cash-strapped families facing higher taxes and reductions in child benefit and other allowances, free GP care for infants must seem like a lifeline in a sea of debt. But the proposal has created an uproar. GPs in particular are finding this particular pill hard to swallow.

We talked to some of the GPs listed on WhatClinic.com to better understand their concerns.

 Dr. Miles Deas, GP at Dr. Deas Family Practice says that there is a lot of fear among Irish GPs when it comes to speaking out about this. “We’re first and foremost patient advocates, but we’ve been deprived of our free speech”, he says, referring to the European Competition Authority taking the IMO to court to prevent it speaking on behalf of GPs. In addition, the gagging clause within the new under 6s HSE contract would forbid GPs from criticising the HSE even when it was clearly failing a patient and it was the duty of the doctor to speak out. “Many GPs are afraid of being reprimanded if they speak out, so we can’t act in the best interests of our patients.” He feels that this scheme does not target care where it most needed, and that medical cards are already being taken off those more in need in order to give free health care to many who are essentially healthy. “I’ve patients who are very sick and lost their medical card asking me what medications they can stop taking as they simply can’t afford them, and that’s a very disturbing decision for a doctor to make” he says. “I’m sure if a parent knew when they brought their child in to see me for free that the old man they just saw leaving my room had lost his medical card and was rationing his treatment and suffering, they would be as unhappy with the new under 6s contract as I am.”

 

On the 16th of April, the draft text of legislation to support this scheme was approved. In theory, it will allow free GP care for all children under six to become a reality by mid 2014. Two months ago a draft contract was produced by the Department of Health.

However, the Irish Medical Organisation (IMO) which represents doctors in Ireland has asserted that it will not be possible to implement this scheme within the planned time frame and that the Department of Health contract has not been negotiated with GPs. They argue that if the scheme is introduced in its current form, there will be adverse consequences for the patient-doctor relationship, highly valued by both parties.

The Irish Government has defended its approach towards the proposed scheme, saying that this is the first step to introducing free GP care for all people in Ireland, and that Irish competition law does not allow for direct negotiation on the proposed fee levels paid to doctors. It maintains that the final say on GP fee levels rests with the Minister for Health, James Reilly.

For its part, the IMO argues that the Government’s interpretation of competition law is flawed. It insists that it will not recommend the free GP cards for children under six scheme to its members unless and until direct negotiations on all outstanding issues take place.

In addition, the IMO is demanding to see the draft legislation text, which has not yet been published.

Dr. Paul Curran, GP at Curran Medical Centre says that he agrees there should be free healthcare for all people in Ireland. However, he feels that the way in which the Government has so far gone about introducing free GP cards for children under six is “an absolute insult” to both patients and doctors. He also detailed instances of chronically ill patients of his who have had their medical cards revoked, saying “There’s not one thing in the proposed legislation that could be negotiated. We need to go back to the drawing board on this and start with a blank sheet of paper”. He would rather emigrate, he says, rather than sign the contract for this scheme in its current form. There is no way that he could accept the gagging clause contained within the HSE contract, as he feels that this would be to the detriment of patients overall. There is a very real risk of waiting lists being implemented, and as these get longer he says he will be in the untenable position of being unable to raise concerns with the HSE.

Meanwhile, the Irish College of General Practitioners (ICGP) has stated that introduction of free GP cards for children under six should not happen until decisions have been made regarding Irish Government proposals for Universal Health Insurance. A Government White Paper on Universal Health Insurance was published on April 2, which in itself has been the cause of much controversy.

The National Association of General Practitioners (NAGP) has said that negotiations have yet to take place on the specifics of the free GP cards for children under six scheme and that the Department of Health is refusing to discuss how the scheme will be resourced.

WhatClinic.com’s CEO Caelen King is a dad himself.

“GPs are at the front line for worried parents. Every Calpol coated parent will recognise that sinking feeling as their child’s temperature continues to climb. Ear infections, endless coughs and colds, that dreaded rash that fails the glass test – sometimes you spend more time in the doctor’s waiting room than you do at home. Taking the financial burden away from tired, frightened parents is a good thing. Like free education once was – it is a milestone of progress and one worth fighting for.

If more parents go to the doctor more often – perhaps for more trivial things – well, so what? There will be times that very sick children will be helped sooner because of it.

Are today’s GP services robust enough to carry the burden that this proposal will bring? Doctors don’t think so. At WhatClinic.com, we see 100,000 clinics across hundreds of countries deal with millions of patients. GPs in Ireland are decades behind GP services in other countries – because we are held back by gross inefficiency and outdated systems.

With a ban on the advertisement of prescription prices, a bonkers system of prescription reimbursement that favours no-one but big pharmaceutical companies and an inefficient medical card system – this may well be the push that causes our front line to break permanently.”

Since there appears to be such a gulf between the views of of Irish Government and those representing GPs, watching this debate as it develops will be very interesting. An invitation was extended to Minister for Primary Care, Alex White, to attend the National GP Meeting at the AGM of the IMO in Carton House on the morning of April 26 and this was accepted. It remains anyone’s guess to see if, and how, a compromise can be reached.

 

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