Procrastination on free GP care extension no longer an option for Coalition

When arguing against the extension of free GP care earlier this year, doctors provided a very long list of reasons why it was a bad idea.

Many GP practices are already full, they pointed out. Large numbers of doctors are approaching retirement, they said, with not enough new ones coming on stream to replace them. Patients would have to wait “weeks” for appointments, it was claimed. The sickest patients would be pushed down the list.

Their opposition has served to delay the Government’s next move towards universal healthcare by several years. Again and again, ministers announced the extension of free GP care, but deadlines were missed.

With the next election starting to loom, though, the Government could no longer afford the continuing procrastination around this voter-friendly proposal. Budget 2023 included funding of €111 million for the extension of free GP care to six- and seven-year-olds, and to people earning less than the median household income.

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[ Free GP care to be extended to 6- and 7-year olds from next month ]

Although its deadlines were again missed, there was a sense of inevitability about things this time, notwithstanding the Irish Medical Organisation’s complaints. So it comes as no surprise that agreement has been reached on the measure, though at the elevated price tag of €130 million.

About 500,000 people will benefit from the change, to be introduced in stages from mid-August. They will no longer have to pay to see a GP, but they will have to pay for any medicines prescribed.

This will be a boon for some families with young children, and those who up to now have been earning slightly too much to qualify for free GP care.

In the long term, their health will improve through more regular attendance at the doctor and exposure to worthwhile innovations such as the chronic disease management programme.

But will they be able to see the doctor? Many GPs have closed their lists to new patients, and it can take days to see some of them due to high demand. The extension of free GP care will only add to this pressure.

“The six- and seven-year-olds will be easiest to accommodate,” says Dublin GP William Behan. “We know from when the medical card was given to under-sixes that demand peaks among children aged under two.”

Behan is more concerned about the additional cards being given on income grounds, particularly for GPs working in areas with young, fast-growing populations.

“General practice is at full capacity. Appointments are not available when people want them. The result of these changes will inevitably be more demand on out-of-hours services.”

The dangers here include a lack of continuity of care, higher rates of overtreatment and excess referrals to hospitals – in effect, spreading the problem of surplus demand more widely in the system.

Behan is certain his patients will have to wait longer when the extra cards are given out, and this may result in delayed care for some sicker patients.

But like most of his colleagues, he will sign up to the new deal, on the basis that “it’s not good PR not to opt in”.

While there will be more pressure on the system, it will be alleviated through the extra funding being provided for practice supports. This will allow GPs to hire more staff, in particular practice nurses who are likely to take on more tasks, thereby freeing up doctors for more complex work.

In the longer term, the number of training places for GPs is being increased and barriers to recruiting qualified staff from abroad are being lowered.

These measures will take time to wash through the system so until then patients will have to make do with a system that is free for more of them than ever before, but less than perfect.