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A year of living dangerously

It is hard to know where general practice is going in 2016. Happy New Year, by the way. 2015 was certainly eventful with the introduction of free, at the point of access, GP care to all children aged under six in the State. A more contentious and divisive issue hasn’t really been seen in my lifetime as a GP and with the threat/promise of free care being extended to all children under the age of 12 this year, I would imagine it’s likely that 2016 may bring a whole heap more fun and games to the profession.

There is no doubt that many practices received an injection of cash from the under-sixes scheme — although it’s hard to know how much private income was lost through its introduction — but certainly the consensus among GPs appears to be that they now spend much of their day seeing (as opposed to treating) little Arabella’s sniffles — sometimes for the second or third time this week, whilst old Mrs Murphy cannot get an appointment for her actual pneumonia.

It was all very predictable, really. GPs said that attendances would go up, and they did. And the HSE told the newly GMS, middle-class under-sixes patients to attend for trivial crap — and they did. You would almost think the HSE was hoping to bring waiting lists into general practice, in line with how they have run the rest of the health service. And who knows, perhaps that’s exactly it. Perhaps a service that provided high levels of patient satisfaction, a same-day service operated leanly with almost zero absenteeism on a low Government spend made them nervous. It was so alien a concept.

A further influx of well under-12s may mean that in fact no one else gets seen in ‘GP land’ ever again, apart from well middle-class children with assertive parents. Not the best use of scarce medical resources, I agree, but in a general election year where the main Government party is trying to woo the middle-class vote of a certain age, that may not be a priority. But sure, what would I know of political horse-trading or management of the health service — I’m just a humble GP.

The other big issue in general practice, as I see it, is the imminent demise of rural practice as we know it. All over the Western world, departments of health recognise that bringing healthcare to isolated rural communities is essential but obviously difficult. It is hard to get bright, young, medical things to work in the ‘back of beyond’. Hard to recruit them and even harder to keep them. It is why Canada and Australia, and even the UK with its strict rationing of health spend, incentivise doctors to go into these areas and work there. Not so here, of course.

Here we have managed to make it insanely difficult for rural GPs to do their job. Instead, we have blindly forced many rural practices into insolvency. Dedication to their patients, not really knowing what else they can do, and sheer bloody-mindedness are the only things keeping some surgery doors open. But of course once they do close, no-one would dream of reopening them or replacing those last stalwarts of a bygone era of general practice.

Ultimately, it is of course the patients who suffer. The old Mrs Murphys with the bad chests. The elderly and the sick in Mayo and Clare. It is their GP service that is slipping away. It is they who can’t get an appointment or a house call, or a doctor at all in fact. It is they who are being told by politicians and indeed others that these changes to how general practice works are in fact the rolling-out of a new service when it is merely a bastardisation of the old one. A monumental ‘emperor’s new clothes’ sleight of hand. An evisceration of resources, manpower and morale.

What I do sincerely hope for general practice in 2016 is that as a profession, we support each other and realise we are colleagues not competitors — as the Competition and Consumer Protection Commission would have us be. That even with our backs to the wall, we still provide a great level of care to the vast majority of patients in this country who never see a consultant or an NCHD from one end of the year to the next. And that without the support of each other, our job and that patient care is becoming unsustainable.

Anyway, welcome to my new column. Just some idle musings, really. But whatever 2016 may hold, speaking out remains key.

Dr Sara Burke is on leave.

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