Given the daily diet of depressing news about various crises in the health services, it’s a shock to realise that the problems we are facing today will be dwarfed by the problems coming over the horizon as our population ages and as demands for the expensive management of chronic illnesses increase hugely. But its true and if we are to have any hope of winning the coming battles, we need to prepare the ground now by investing in General Practice to ensure it has the skills and the resources to lead the fight on chronic illness. Perhaps this can inform the vision which our Minister for Health and his senior advisors acknowledge has been lacking from health service planning for too long.
The challenge we face arises from the relatively sudden and quick aging of the population. Not surprisingly health is inextricably linked with age and as people get older they succumb to a range of chronic illnesses which require close monitoring and management which comes at an increasing cost.
For decades the proportion of the Irish population that was over the age of 65 was static at just under 11%. But that has now begun to change and the pace of change will accelerate rapidly in the years ahead. Current forecasts suggest that the percentage of people over the age of 65 will rise to 26% by 2026. About 20,000 additional people are passing the magic 65 years of age milestone each year and the actual number of people over that age will double in the next few decades. Within that the number of “older old”, people over the age of 80, will double.
This is good news for many but it brings with it enormous challenges. People over the age of 65 already account for a huge portion of our health service costs. They are susceptible to chronic illnesses and typically more than one chronic condition at a time. They account for a disproportionate number of hospital beds and and prescription medicines.
The other complication is that as the proportion of the population over the age of 65 increases, the proportion of young people at work whose taxes pay for our health services is going to decrease significantly. It’s a perfect storm; rising demand for expensive health care with falling numbers of young, healthy people of working age to pay for it.
Of course Ireland isn't alone in experiencing this phenomenon. The only thing that is different is that most other European countries are ahead of us and have had more time to plan accordingly.
The lesson from their experiences is that the only proven way to rein in run-away health service costs is to invest in General Practice. If prevention is better than cure, then the investment needs to go to that area of the health services which is best equipped to prevent small health issues becoming bigger health issues which demand hospitalisation, surgical treatment and the like.
General Practice in Ireland has a network that any private company could only dream about - much less afford to construct. It reaches into every parish and community in Ireland in a personalised way. It delivers 95% of all health needs despite being woefully under resourced - attracting a mere 2.5% of total health spend. It has an approval rating from patients which consistently positions them as the most trusted cohort within the health system .
But all is not perfect. Recent surveys demonstrate, unfortunately, the enormous stress levels General Practitioners are experiencing and while the rate of absenteeism due to illness is miniscule, we are for the first time witnessing vacancies which are attracting no applications and young doctors choosing emigration over the demands of working in a hostile GP environment.
We have trained over 800 General Practitioners over the past number of years - many of whom have left due to the hostile environment that is General Practice
General Practitioners are best positioned in the Health system to deliver chronic disease management, with evidence to support the equivalent if not superior outcomes. A shining example is the Midlands Diabetic Shared Care Strategy which has been operating for the past 10 years - the recent audit report of which will demonstrate what can and is being achieved in General Practice. What made the difference here - Structured Care - and this can be replicated for other Chronic diseases.
There is a health warning with everything and this is no different. To deliver such a service requires a healthy and robust General Practice along with the necessary capacity to deliver same. Unfortunately this has been undermined over the past number of years as a result of resource cutbacks - leaving a dispirited General Practice workforce with capacity issues.
Capacity will be an issue irrespective of which vehicle is used to deliver chronic disease management in a coherent manner. The capacity can be generated by creating an environment whereby General Practitioners would chose to return from abroad to work in a Health Service fit for purpose, a Health Service capable of delivering services to patients in a timely and value for money manner; a Health Service we can all be justifiably proud of which will serve our patients, our families, our colleagues, our friends.
Dr. Padraig McGarry is Chairman of the IMO GP Committee