THE STATE OF GENERAL PRACTICE
FIT FOR
THE FUTURE
With the new €210m deal that has been struck with Government, can GPs look forward to some respite? We talk to five alumni about the legacy of underinvestment in General Practice and how it impacted on their workload, morale and patient care
R
ecent years have seen hardworking family doctors deal with rising demand from patients while enduring funding cuts in General Practice. The new deal announced in April will see the long-sought reversal of the controversial Financial Emergency Measures in the Public Interest Act (FEMPI) cuts of €120m (plus €10m in pension contributions) imposed on General Practice at the height of the financial crisis which have been a major source of anger among GPs. An additional fund of €80m was secured for the management of GMS patients with chronic disease in the community. “This is an important step towards investing in General Practice and valuing it as a vital part of the health service,” said Chair of IMO GP Committee, Dr Padraig McGarry. “GPs will receive their restoration of FEMPI in four stages. The first increase will become effective in July 2019 with phased increases in January 2020, 2021 and 2022.” Although there is no official register of GPs in Ireland, it is thought that there are more than 2,500 currently practising, and there are more than 4,000 members and associates of the Irish College of General Practitioners (ICGP), comprising over 85 per cent of practising GPs in the Republic. The HSE predicts a shortage of up to 2,055 GPs in Ireland by 2025. The current shortage of GPs is the legacy of a decade of funding cuts and the additional demands placed on them and their resources by an ageing population, with the emphasis on primary care by successive governments adding ever more pressure. According to the ICGP, there are 690 GP trainees. The numbers have increased in recent years and the ICGP estimate that 192 trainees will be
recruited for the 2019 intake. However, according to some reports, once qualified, there is a problem with retention. Up to now, young doctors simply have not seen General Practice as a viable career, and the job has become less attractive, with more work required for less pay. The current system means that, in order to make their practices viable, GPs have to take on a large number of medical card holders. The result is that they are overstretched, and patients are placed at risk. There are now approximately two million patients with medical cards or GP-visit cards in Ireland – 40 per cent more than eight years ago. Yet the FEMPI cuts in 2009 meant funding was cut for General Practitioners by 38 per cent and this led to the current crisis. Many GPs closed their practices to new patients. Seventeen per cent of GPs – 700 of them – are due to retire in the next four years. The burnout rate among GPs – particularly in rural and deprived areas – is high, with many worn down by paperwork and administration, waiting lists and the inability to secure services for their patients. The impact on family life is devastating The recently announced investment in primary care and in keeping patients out of hospitals is long overdue. The cost of treating a patient in a hospital bed is €1,200 per night; while the cost of treating a patient in their own bed is less than €100 per night. According to a recent paper published by Deloitte, every €1 invested in primary care saves €5 in the rest of the health service. In a recent survey by the ICGP, 52 per cent of GPs said they would opt for another career, if they could choose again. Over 66 per cent stated they would advise their children to follow a career other than General Practice, and 31 per cent planned to leave General Practice in the next five years. It is hoped that the latest initiative will help reverse this.
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