A decision to see a doctor should never be a financial dilemma

We have come a long way since the defeat of Dr Noel Bowne’s Mother and Child Scheme in 1951. Our health services are immeasurably better than they were in the past despite enormous pressures, especially since the economic collapse of 2008.

But money still talks when it comes to access to healthcare in Ireland, with consequences that are graver in primary care than in any other sector.

There is extensive evidence that GP fees are a barrier to accessing healthcare. It is a sad truth that some parents who are not eligible for a medical card are simply unable to pay the fee needed for their sick child to be seen by a GP.

It is also the case that fees are a proven barrier for GP attendance, even for those of us who are relatively better-off. People risk postponing a doctor’s visit even when they may feel something is wrong. And they are even less likely to attend for a periodic check-up, which would make sense for all of us.

Ireland is the only EU health system that does not offer universal coverage for primary care. If we are serious about shifting resources and attention to this sector – as I believe we must – then we will have to start by removing the barrier of fees for GP attendance. A decision whether to see a doctor should never be a commercial or financial dilemma – for any citizen.

When we talk about “free GP care” we mean a system of universal access without fees at the point of use. This will be the bedrock of our primary care system from which enormous advantages will flow. It will allow for early diagnosis and treatment, relieving pressure on the (vastly more expensive) acute services. It will mean that we can manage and plan healthcare delivery on a population-wide basis where every citizen is registered with a GP practice.

Most importantly of all, it is only with a well-functioning primary care system that we can have any chance of addressing and managing chronic illnesses – by far the biggest challenge facing modern healthcare systems.

This week the government published the Health (General Practitioners Service) Bill 2014, proposing the extension of free access to GP services to some 240,000 children across the country who are aged five or under (“the under 6s”). We have provided funding of €37 million to meet the cost of this project. And it’s worth stressing that this is extra funding; it is not in any way derived from savings made up elsewhere in the health service, whether in the medical card system or otherwise.

Some have asked why we have chosen to extend free GP care in the first instance to children aged under six. The answer is that this is the first step in a population-wide project, and young children are a health priority group. Access to GP services will increase the likelihood of childhood conditions being identified earlier and being addressed. As the IMO Position Paper on Child Health 2012 notes, ensuring that children have the healthiest start in life provides the basis for good health in adulthood.

I think there is a general welcome for the under 6s initiative – especially, and understandably, from young families. But it is true that the practical implementation of the plan has attracted opposition from doctors. Over recent months, GPs have organised and communicated their concerns vocally. I have met many doctors across the country, and listened attentively to their views, and I was pleased to attend yesterday’s GP meeting at the IMO Annual Conference.

I am keen to address, and to respond as best I can to the concerns that have been raised. But I have refrained from engaging in public spats or confrontation. I want to work with GPs to create a suitable, acceptable and pragmatic new contract – initially for the provision of free GP care for children, and ultimately for the universal system that we want to implement.

But we can only do this together. The constraints posed by competition law may not be ideal, but they should not be over-played. I am prepared to negotiate on all aspects of the scope and content of the contract. It is only the actual setting of fees that must remain ultimately a matter for the Minister. But here too there can be real input from the GP bodies, as is clear from the Bill now published.

Pending the commencement of engagement with GPs representatives, we have been looking closely at the almost 300 submissions received as part of the public consultation process on the draft contract. In their written submission the IMO set out their concerns in respect of the draft contract and I earnestly wish to address these concerns directly with them.

The draft contract – and I emphasise that it is a draft – is the opening position of the Department of Health and the HSE. It is amenable to change, even radical change, on foot of our proposed engagement with the doctors.

I have invited the GPs’ representatives to meet with me, and to engage in discussion and negotiation. I extended that invitation again at yesterday’s conference.

I have also heard the fears of GPs that their surgeries will be overburdened with additional visits from children. The projections available to me do not support such fears, however genuinely held. This is an aspect that we can usefully explore in our negotiations, when we can exchange research and seek to reach agreement. And we can also look at ways to monitor the new scheme once it is established.

It seems to me that the public wants the Government and GP bodies to come together, to resolve our differences and find a workable solution. I’m not saying this process will be easy – change never is. But by doing so, we can implement an historic and progressive health policy for the benefit of our children, and ultimately for the health and wellbeing of our entire society.

How better to cherish all of the children of the nation equally?

This article by Alex White TD, Minister of State at the Dept. of Health and Labour TD for Dublin South first appeared in the Sunday Business Post on Sunday April 27th 2014.