Family doctors have warned further increases in eligibility for free GP care in the absence of increased capacity will jeopardise the provision of same-day services and lead to waiting lists.
The Irish Medical Organisation (IMO) told the Oireachtas committee on health that even if general practice was fully funded tomorrow, there would not be sufficient capacity in the system to deal with predicted additional workload.
Dr Pádraig Mc Garry said the introduction of free GP care for children under six had brought in 240,000 additional patients.
Referring to the the new blueprint for the development of the health service, he said: “In the Sláintecare report it is recommended that free GP care is extended out to 500,000 additional patients per year.
“As it currently constituted this will lead to waiting lists in general practice as demand will outstrip supply.
“Additional supports for infrastructure and practice staff, specifically additional practice nurses, will be needed to allow GPs to build up capacity.”
Meanwhile, the Irish College of General Practitioners said the position of practice nurses in the Irish primary care system was "Victorian" and a matter of major concern.
Dr Brendan O’Shea told the committee that nurses working in general practices were paid significantly less than their counterparts in hospitals. They had no maternity leave, no educational leave or supports and no pensions.
The general secretary of the Irish Nurses and Midwives Organisation(INMO) Liam Doran told the hearing that at present GPs running medical practices received a grant from the State to employ nurses.
However he said the practice nurses may not receive all of this money as a salary. He said in addition the practice nurses also performed services in clinical areas such as administering the flu vaccine or performing cervical smear tests for which the GP received a separate fee.
He said one survey his organisation carried out suggested practice nurses generated up to €112,000 in fees.
Mr Doran said the current system was “neither fair, reasonable or sustainable” and that practice nurses should be employed directly by the State .
He also said that all new GPs should be directly employed by the public service as distinct from being independent contractors as at present.
The president of the National Association of GPs Dr Emmet Kerwin said the Sláintecare report recommended an impact study be carried out on the effect of separating private from public practice in hospitals. He maintained it was "only logical" that a similar exercise be conducted into the implementation of free GP care.
“The Minister for Health has acknowledged that GP services are put to the pin of their collar and that there were lessons to be learned from our experiences in the introduction of free under-six care to our population.”
“We have already seen through the under-six [free care programme] the effect of what we call service-induced demand on a GP system which lacks capacity and the increased activity that free GP care has brought.”
Dr McGarry said consideration should be given to supports for GP principals to hire additional doctors as well as administrative back-up.
“Many practices will need to physically expand to cope with the additional workload and create capacity. This may require grants for extensions, additional rooms et cetera.
“GPs must be able to access diagnostics and allied health and social care professionals on an equitable basis.”
He said the availability of a same-day service and continuity of care was what made general practice work well.
“By increasing demand — availability of service free at point of use — without also increasing capacity we may threaten these very principles.”
Dr McGarry told the committee on Wednesday there were currently 666 GPs over the age of 60 who would be retiring in the next five to seven years.
He warned that given the existing difficulties in recruiting GPs, “rural areas are likely to be most affected”.
