The first cut is not always the deepest

Further cuts in GP fees will be bad news for doctors and patients alike, says Dara Gantly

News coverage can come about for many reasons. An event happens, is reported on, or generates reactions that are themselves turned into news. Equally, hard news often involves reporting on events about to happen. This all seems simple enough, except that news can also be manufactured, or at least chosen to be reported at certain times, for various reasons.
One could not help wondering about such things when reading the report last month of the latest payments to GPs operating in the general medical services (GMS) scheme. Usually released in August, the GMS payment figures came out early this year, ahead of an expected announcement by the Minister for Health of further cuts in GP fees.
And what did the figures show? Total payments to the 2,200 doctors operating the scheme increased by about €25 million (to more than €500 million), despite two separate cuts in fees introduced by the Government last year. Of course, GPs had to work for it; the number of patients covered by the medical card scheme has soared over the past year by some 120,000. And how many outside the profession realise that the payment to Dr Joe Bloggs has to cover the salaries of three other doctors, a practice nurse, two secretaries and the overheads of a busy practice?
At time of going to press, the Minister had yet to make an announcement on further reductions in professional fees under the Financial Emergency Measures in the Public Interest Act. But such a decision does seem ‘about to happen’ (if it hasn’t already, by the time you read this). What is entirely predictable is the consequence of such a move.
The majority of GPs seem to have been able to absorb the loss of practice income over the past year, due to the 8 per cent cut in fees and reduced private income. If further cuts come, most will probably have to cut staffing. This will result in fewer partnerships being created, fewer assistants taken on and fewer doctor hours. And if you have fewer nurses and practice managers in support, a lot of the pro bono work – such as chronic disease management, which the State has never funded properly – is likely to be divested.
It is also possible patients could be referred back earlier to secondary care due to additional financial constraints placed on GPs, and obviously spending on so-called ‘extras’, like ongoing investment in ICT or diagnostics, will be slashed. The news won’t be great, for doctors and patients alike.