GP child visits soar after launch of free care

The number of under sixes treated free of charge by GPs more than doubled at some practices following the introduction of free care for young children, according to a new study.

Researchers at the Department of Public Health and Primary Care at Trinity College Dublin found the number of children under six seen free of charge at eight practices in north Dublin went from 5,017 in the year before the policy change in 2015 to 10,824 in the year after.

These children made a total of 17,290 visits to GPs.

The researchers studied daytime general practice services and their local out-of-hours service, called NorthDoc, which offers urgent GP services from five treatment centres in north Dublin. It covers 140 GP practices, including the eight used in the study.

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In July 2015, all 440,000 children aged younger than six in the Republic were granted free access to general practice visits, regardless of parental income. The policy change allowed 300,000 additional children free visits to both daytime and out-of-hours care settings.

The number of children aged under six who used the daytime general practice services at least once increased by 9.4 per cent while the number of visits grew by 28.7.

“Introduction of free general practice care for all children aged younger than 6 years led to a significant, if predictable, rise in the number of children seen free of charge and a sharp fall in the number paying out of pocket,” the study published in the journal Annals of Public Medicine said.

“The out-of-pocket number did not drop to zero, however, as some parents used general practice services before completing the application process for free visits. Overall, 9 per cent and 20 per cent more children attended the daytime and out-of-hours services, respectively, at least once in the year after the policy change.”

Although both the daytime and out-of-hours services saw more patients of all ages in the period after the policy change, children aged younger than six years accounted for a “disproportionate” increase in service use, the researchers said.

Some 45 per cent and 73 per cent of the additional visits in the year after the policy change to the daytime and the out-of-hours services, respectively, were by children this age.

The study said further research was needed to establish whether severity of medical issues changed when access was free and whether increased workload had effects on general practitioners and patients.

“Demand for general practice services is increasing worldwide, both in daytime settings and out-of-hours settings,” the researchers wrote.

"Equitable access should be a cornerstone of any health care system, but making services available free of charge inevitably increases service use. In the Republic of Ireland, there are already indications that the general practitioner workforce may struggle to meet demand in the near future, so future plans to extend state-funded general practice care to all groups will require careful workforce planning."