Analysis: Primary care practitioners insist cuts have consequences

The health service and thousands of GPs, pharmacists, dentists and other contractors who provide primary care services have been struggling in recent years to deal with increasing numbers of patients at a time of significantly reduced funding.

The State’s bill for these services is enormous – some €2.5 billion per year. However, the volume of transactions handled by the HSE’s primary care reimbursement service is equally mammoth – at around 78 million in 2011 it is up 2.8 million on the previous year.

This is perhaps unsurprising as growing unemployment over recent years has seen a dramatic increase in the number of people qualifying for medical cards.

Since the onset of the economic downturn the Government has sought to tackle the costs. It has invoked emergency legislation to reduce fee levels to primary care contractors on a number of occasions.

And the end of the cuts is not yet in sight, with the Government planning to generate around €70 million more in savings in fees in this area this year.

This plan was announced in the budget last December, and although a consultation process was put in place at the start of the year, Minister for Health James Reilly has made no decision on this issue as of yet.

A spokesman for the Department of Health said last night that the issue of the proposed cuts was still under deliberation.

However, primary care practitioners have warned that the cuts imposed to date have not been consequence-free.

The chief executive of the Irish Dental Association, Fintan Hourihan, said last night that "significantly reduced payments to dentists reflect savage cuts in services to patients holding medical cards and explain a large rise in redundancies and practice closures".

GPs have also warned that the existing cuts as well as those proposed for this year are leading to the running down of general practice.

The annual conference of the Irish Medical Organisation (IMO) heard this month that waiting lists for appointments to see GPs could be common in the future.

The IMO had also previously warned that further cuts would reduce the capacity for general practice to provide chronic disease management and would set back the Government’s plans for the introduction of universal GP care for many years.

Representative bodies for GPs and pharmacists also argue that the publication of lists of earnings are misleading as they represent gross figures and do not take account of practice expenses.

If the Government is to generate the €70 million in savings sought from professional healthcare fees this year, the Minister is expected to have to make a decision on the scale of the new cuts in the near future.

A lot more argument can be expected at that stage over both the need for savings and the implications for the services provided by doctors, dentists and others to patients at primary care level.