Controlling general practice

The HSE can think again if it believes it can dictate to GPs how they provide care to their patients, says Dr Illona Duffy

So, the attacks on general practice continue. The media is leaked the stories about greedy GPs and the ever altruistic Government is going to sort it all out and make sure we stop fleecing our patients. Batt O’Keeffe is going to take control and decide how much we can charge our patients.

Well, you know what, I say role it on!

Mary Harney tried this before. She was going to insist that we all put up price lists and be transparent about our charges. Then suddenly, as her Department started looking at what we do and what we could charge for, it all got a bit worrying.

What if it actually showed the GPs what any businessperson believed they could (and should) charge for? What if suddenly they started itemising their work? What if a basic consultation was just that, with every extra item of service having an extra charge? What if we actually started charging private patients for every visit? What if we started charging for telephone consultations rather than it actually costing us, the service provider, to treat and advise the patient?

I mean it is ridiculous that we ring patients (usually on mobile numbers) and not only provide our time for free but actually incur the cost of the phone call. It’s completely laughable.

Billing for work
Forty years ago there was a GP in our locality who would gladly offer medical advice to the patients who met him while out walking. He smiled, talked, advised and then sent a bill in the post! Meanwhile, I scurry around Tesco, head down, busily studying my shopping list, all in an attempt to avoid eye contact with patients. Then I have to be careful which checkout desk I choose as I have learnt the hard way how much medical advice one can be forced to dispense in the long, long time it takes to unload a trolley, pay and pack all the shopping. A bill in the post might well stop all such medical queries.

But back to Batt and his wish to rule on how much we charge (it would be highlighted in the press, on the radio and even TV).

Every private patient would now be told that yes, there is a charge for seeing the doctor and the ‘do I owe you anything?’ question would end. Every patient walking in the door would now expect to be charged for each and every visit and, of course, given that we were having to go by Batt, we would have to charge. I know for a fact that I would see a rise in my private income.

Every cloud has a silver lining they say, but this one could actually have a gold lining.

I did an out-of-hours shift in the regional co-op on Monday night. I came home to my baby sitter who is a medical student and told her there and then not to ask me if I liked my job. I hate, detest and abhor having to do on-call work.

There are many reasons; I work hard during the day and resent having to then do more work at night; I want to see my kids and resent not seeing them until the next day; I can’t believe that I have to go out at night and work for less money than I get during my day job; I find it stressful dealing with patients I don’t know; I hate that patients will demand more home visits and prescriptions because they are dealing with a doctor who doesn’t know them and therefore cannot play hardball with them.

On-call work
It’s amazing what a recession can do, as I swore I would never do on-call again. But here I am slowly weaning myself into it. Then the HSE announces that they are changing our whole co-op. It’s back to an STC system with centralised nurse triage.

The Executive, of course, seems to have forgotten that it was the GPs in the region who came together to form the co-op in the first place and that the level of care being provided is not only excellent but also accessible and appropriate.

It also seems to have forgotten that it has been boasting about the wonderful out-of-hours service being provided by the co-ops, with Mary Harney promising that the co-op-less black spots would see the light under her charge.

Well watch and wait; the HSE needs to be very, very careful. GPs have changed and they are no longer willing to sacrifice their family lives for the job. We will not allow the HSE to control us and dictate how we provide our service; we will not be tied to SLAs; and we will not have our clinical autonomy challenged by HSE-trained triage nurses and HSE enforced quotas.

Work to rule
GPs can decide to change the level of out-of-hours cover we provide. We can reduce the numbers of patients we see and start to work to rule with our contracts, which will lead to a huge increase in the numbers attending hospital. We can and will protect ourselves. Ultimately, the HSE will do what it has done in the hospital sector — it will make it more and more difficult for patients to access the care they need, unless we stand firm and refuse to let it take control.

Mind you, the NTPF is looking for more ways of justifying itself, so perhaps it will offer midnight calls by a private GP if patients are waiting more that three hours.

You never know, we might see ourselves actually doing private on call at premium rates for them.