Vision fine, but reality likely to be much less

"They are not available, not at all."

"They are not available, not at all."

The speaker is a doctor in Galway who was pouring cold water on the vision of a country dotted with buildings containing GPs, physiotherapists, occupational therapists, nurses, home helps, care assistants and God knows what else.

His point was that it will be many a long day before he can install a physiotherapist down the corridor to whom he could refer patients because paramedics are in terribly short supply.

This doctor did not want to be named for the simple reason that a 15-hour day yesterday and the day before had left him with too little time to read up on the health and primary care strategies.

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And though doctors are delighted with the commitment to put massive funding into primary care, he is not the only one who doubts that the vision set out by the Minister for Health yesterday can be achieved to the full.

First, however, there is likely to be a huge row between doctors and the Government over medical cards. The revelation yesterday that there will be no increase in medical card eligibility until 2003 has angered doctors.

As Clonmel, Co Tipperary, GP Dr Kevin Kelly put it, "I would not support this in any way whatsoever" unless more people get the medical card.

Dr Kelly, who is on the Irish Medical Organisation's GP committee, takes the view that no matter what is in the strategy document he will have nothing to do with it for as long as there are low-paid people who cannot afford to come to him and to other GPs for treatment.

It is, he said, "outrageous" that a situation can continue in which people develop chronic asthma and heart conditions and in which diabetes goes undiagnosed because the cost of several trips to a doctor in a year is beyond them.

The IMO itself took a similar view, though couched in more sedate language. "Any decision to delay the extension of eligibility for the medical card would be unacceptable and undermine the health strategy's guiding principles of equity, access and fairness," it says, quoting the figure of 250,000 people who, it says, cannot now afford treatment.

That row will be resolved at some stage but it is likely that for as long as the Government sticks to its guns, the work on implementing the new vision will be delayed. The vision itself could become slimmed down in a variety of ways as it comes up against some inevitable realities.

Will it really happen, for instance, that GPs and other health professionals including even social workers, will be available to the public in spanking new primary care centres morning, noon and night as envisaged?

If health boards are already short of physiotherapists, nurses, social workers and other paramedics, is it believable that the numbers can be made up to make such professionals available in 600 primary care centres in the next 10 years? Or that health board employees will work in the evenings?

Dr Kelly believes it is unnecessary to have everybody sitting in the same building offering their diverse talents to patients. Why can't the physios and public health nurses be based in their own local health centres and be available for referrals from the primary care team?

Why can't information technology link GPs with hospitals so that, for instance, tests carried out by GPs do not have to be repeated in the hospital? Indeed, Beaumont Hospital in Dublin has already developed a scheme to give GPs the results of tests electronically.

The Irish College of General Practitioners has suggested that, in the early stages at least, the primary care team consist of GPs, practice nurses and community nurses.

In the long run, the glittering vision outlined by the Minister may be achieved. But the reality may be more akin to a network of group practices, made up of doctors and nurses, well-funded to do tests and some other work now done in hospitals - and that will be an improvement in itself.

But first there will be that row over medical cards.

pomorain@irish-times.ie