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Free GP care for under sixes led to a significant increase in service use

In July 2015, all 440,000 children under six years of age in Ireland were granted free access to daytime and out-of-hours GP services, regardless of parental income.

A new study, conducted by researchers at the Department of Public Health and Primary Care at Trinity’s School of Medicine, has found that the introduction of free GP care has led to a significant increase in visits by children under six years to both daytime (29 per cent increase) and out-of-hours services (26 per cent increase).


The study involved an examination of visitation data from eight GP practices in North Dublin and their local out-of-hours service (NorthDoc). Over 300,000 face-to-face consultations occurring over one year before to one year after the introduction of free care were analysed. The research has recently been published in the journal ‘Annals of Family Medicine’. 


The study also found that while use of daytime and out-of-hours services increased across all age categories over the study period, the under sixes were responsible for a disproportionate amount of the increased workload. 45 per cent of additional visits to daytime GP services in the year after the introduction of free care were made by children under 6. This cohort was responsible for 73 per cent of the increase in visits to out-of-hours services. 


“It is no surprise really that GP services are used more often when free,”  said  lead study author Dr Michael O’Callaghan, general practitioner and researcher at the School of Medicine’s Department of Public Health & Primary Care, Trinity College Dublin.
“This study shows conclusively that large numbers of additional children availed of GP services and availed of these services more often once they gained free access. Our study also demonstrates the ‘knock-on’ effect of the under sixes contract in the out-of-hours service, which experienced a disproportionately large spike in numbers of children under six attending.”


“GP services in Ireland are getting busier in general, and this was also demonstrated in this study, with GPs seeing more patients of all ages in the second year of the study. However, almost half of additional visits to the daytime services, and three quarter of the additional visits to the out-of-hours service were generated by the under 6s. As we have no reason to believe that the cohort experienced more ill health in the second year of the study, we can conclude that the large increases were simply as a result of the introduction of free GP care.”


Prof Tom O’Dowd, Fellow Emeritus, Public Health & Primary Care, Trinity, added: “This study shows that workload planning is required when any changes to GP access are made. If not, access to front line GP services will be undermined for everyone.”

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