Free GP Care for Under-6s...An update

So what's happening about the free GP care for Under-6s, didn't the Government promise it

would be in place by Summer 2014? 

'Government in broken promise' shocker. It's hardly a new headline...


So what's happening about the free GP care for Under-6s, didn't the Government promise it would be in place by Summer 2014?  'Government in broken promise' shocker. It's hardly a new headline.

Clearly just announcing that the Government could provide free GP care for every child aged 5 and under doesn't result in it automatically happening. Especially when they hadn't at any stage negotiated with GPs about how this would happen. Or, more importantly, hadn't even asked if the Under 6s were the right group to prioritise when the whole health service is in chaos, at a time when General Practice is holding it together on a shoestring and in particular when we have so many patients (not just under-6s) who don't have a medical card and who can't afford to pay for GP visits, medication or other medical expenses who are arguably more deserving of free care than most.

There is no money for free GP care for everyone. So the Government should stop pretending there is.

Even the €37m 'new money' that was 'set aside' for this has since been spent on hospital budget overruns and is coincidentally (and insultingly) the same figure as that which was cut from GP budgets in the last (5th) round of FEMPI cuts, resulting in more staff cuts and reduced service.

Recently the figures mentioned were €25m for Under-6s and €12m for over-70s. They haven't a clue how much appropriate care even costs.

So why hasn't free GP care for young children happened?

It's fairly straightforward. Some non-GP anonymous HSE manager types put together a truly horrendous draft contract for this new service in 2013 (unseen by any GP organisation until late Jan 2014), and thought it would work. It was not only rejected by GPs for being entirely unworkable for many reasons (related blog post here), but has managed to incite a new level of something close to hatred by GPs towards the HSE and Government. This draft document wasn't even circulated to GPs and it began to dawn on the powers thatbe that perhaps they needed to have GPs on-board.

They have gone back to the drawing board, and are thinking of actually speaking to GPs about it this time.

Why would GPs not want free GP care for under-6s?

Most GPs in the country are in favour of our patients not having to pay to see the GP and are in favour of a properly resourced 'free' service for everyone. The so-called 'Universal Healthcare' model.

In fact, GPs who have worked in countries who have a properly-resourced and well-functioning General Practice system, with 'free' GP care for everyone, are in many cases leaving Ireland and moving to those countries for better job satisfaction, as they know such a system won't happen here in the next ten years.

The problem is, there's no such thing as a free lunch, or free medical care. It costs money.

Free GP care costs far less than free hospital care (very approximately one-tenth as much, they currently spend one-fortieth on it in Ireland) but still costs money.  However, as most people know, the country is broke. There is too much money spent in administration in the HSE and no new money to move from 40% of the population having free GP care to 100%. So the reason GPs seem overly negative about this concept is that we know better than most how little chance there is of moving some of the current hospital budget to General Practice to provide free care for more people.

The Government said the Under-6s will be the first to get free GP care (in a vote-winning stunt) and they want you to believe that everyone else will follow. They even listed the next 2 groups recently (without negotiating with GPs, obviously) – as the remaining over 70s (90% already have a medical card) and the 6-12 age group. Unfortunately there is no money for this either but they hope you, the voting public, will keep them in office because of these laudable but false promises. They want you to blame GPs, not politicians, when it doesn't happen.

The other problem is that since the 5 FEMPI cuts many GPs are working in insolvent businesses, can't afford to pay their staff, their running costs, and/or themselves every month, and naturally want to get that huge problem fixed first before agreeing to any new work.

Free GP care for those most in need first..

It is immoral to put what scarce resources we have into providing free GP care for healthy and wealthy kids based on age, not medical need. We would like if everyone could have free GP care (who wouldn't?), but we know there isn't enough money. It is all tied up in union-driven hospitals, admin, pensions, and elsewhere. GPs believe the next group who should get free GP care are those who are just over the threshold for medical cards and who can't afford to go to the doctor (including some under-6s, but loads of others - possibly you or someone you know?), and those with complex medical problems who can't afford to pay for all of their medical care.

Instead all Under 6s, including the children of high earners, are getting a promise of free care in preference to those who can't afford to pay. I have an almost 2 year old son. I do not want him getting a medical card before others, or at all. That is unethical and not what I signed up for as a doctor.

So why are the HSE/DOH still talking about a new Under 6s contract if most GPs won't sign up to it?

The problem is that free GP care for under 6s is not just a bad theory, it's now "the law".

Despite our protests, the people who run our country signed this into legislation so apparently have to try to find some type of service providers to provide it, ideally GPs. (See here for an earlier related blog post...)

They have realised too late that this was not a clever decision. The Irish Medical Organisation (The union which has traditionally represented GPs) have had  preliminary talks about talks with the Government on this issue, it would seem mainly to inform them of all aspects of the draft/daft contract which are unworkable and why this is the case.

It is a damage-limitation exercise, as the Government may be intending to produce a less offensivedraft contract soon. One which it is assumed will still be rejected by GPs as being the wrongsolution, according to GP polls. But they are obliged to try to fulfil their promise.

However, they haven't yet agreed to talk to the NAGP who represent about 1200 GPs.

Is there a solution?

What needs to happen is for our Minister for Health to admit that his predecessors made a mistake with the Under-6s legislation, and that it is wrong to deny free GP care to those most in need in favour of all Under-6s. People who can't afford to go to the GP should be prioritised, those who can afford to should not be given medical cards just because of their age (until funding is available for all).

The Minister should make an arrangement to begin talks on a long-overdue new GP contract with our representative organisations, in tandem with a realistic look at a new GP budget (10% of the current total spend on Health would be a good figure to start with), to provide free GP care for all down the road. This should include structured and resourced chronic disease management, and reflect your future healthcare needs and those of your family, while reducing pressure on hospitals. This is what most GPs want on your behalf. It's not currently deliverable. Don't hold your breath.


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