There was the boy with the sniffle; the mother who brought her baby to the doctor on the childminder’s say-so; the parents looking for a cert so their child could go back to creche.
Doctors do not talk publicly about their patients, for obvious reasons, but in private it does not take long for their exasperation with the under-six scheme to show. The anecdotes many tell point to a rise in visits for minor complaints.
"We're disempowering people," says Mary Rogan, a GP in rural east Galway. "They're ringing out of hours when they haven't even checked a child's temperature or waited for a day. We shouldn't be doing this to people."
William Behan, a GP in Walkinstown, says that for every 30-50 children treated out of hours since the scheme came in, three might need antibiotics. "You're dealing with more trivial illnesses, or illnesses at an earlier stage."
Signed up
More than 220,000 children under six have been signed up for the scheme by their parents. Most doctors are operating it. However, the extra demand is causing knock-on effects elsewhere. And it will cost a lot more than projected.
More people are going to emergency departments. The number of daytime patients is manageable, most doctors say, but other patients find it harder to get early appointments.
Emergency department attendances at Crumlin hospital are up 20 per cent while many clinics report rises of more than 50 per cent in evening callers. More patients are now being seen by a doctor other than their regular GP.
“It’s less clinically efficient. An out-of-hours doctor doesn’t have a patient’s notes and history, and doesn’t know the person,” says Rogan.
“You’re far more likely to be referred to A&E by a doctor who doesn’t know you,” says Behan
Tom O’Dowd, a GP in Tallaght, agrees that free under-six care “hasn’t made a huge pile of difference” during the day, but the evening load has increased by 50-60 per cent. “Most of the extra visits are from parents working during the day, who are responding to the creche telling them their child isn’t well.”
Extra caseload
While other doctors say much of the extra caseload involves trivial illness, O’Dowd disagrees. “Most need to be seen. They’re acutely ill, thanks to the flu outbreak or the rise in viral illnesses this winter.”
The spike in visits to evening surgeries has generated huge income for some GPs, he says, as doctors are paid €42 per visit for out-of-hours work, compared to €125 per additional under-six in their daytime practice for the entire year.
Not surprisingly, the scheme is hugely popular with parents; O’Dowd says his feedback is 90 per cent positive. Under-sixes qualify for a GP card only, which does not cover drugs. Most people, though, are clear about their entitlements.
However, Mayo GP Keith Swanick says extra free care is changing attitudes. Before, parents would be told that their child had a virus that would go away in two or three days.
“In the past, that would have sufficed, but now they’re back after two days,” he says. “You see them again okay, but you’ve taken a consultation needed by another patient.”
Attitudes
GPs strongly resisted the scheme’s introduction. But the market has changed attitudes, with parents moving their custom from doctors not providing free GP care to those who quickly signed up. Late-signing doctors have not won patients back. Objections to the scheme have not gone away.
"In the context of a healthcare system in freefall, it was a bad use of resources," says Ray Walley, a GP in Dublin and president of the Irish Medical Organisation (IMO).
Despite misgivings, the IMO recognised that the Government was determined to introduce the measure and negotiated a deal that cost twice what the Department of Health had originally budgeted.
Walley believes the scheme is partly to blame for this winter’s chaos in hospital emergency departments.
“Give people free access to a service, and obviously they will use it,” he says.
Later this year, the Government wants to see all children under 12 covered. It is not a prospect welcomed by doctors .
“I can see myself going out of business,” says one.
