Patients referred to hospital consultants are being kept unnecessarily in the hospital system, clogging up resources and adding to the pressure on the health services, the Irish Medical Organisation's annual Doolin Memorial lecture has been told.
Patients were not being referred back to their general practitioners as they should be in many cases, said Dr Michael Boland, director of the postgraduate centre of the Irish College of General Practitioners, who delivered the lecture.
Calling for reform of the referring system, which would reduce the demands placed on hospitals, Dr Boland said in some hospital clinics there were numerous repeat attendances, up to 90 per cent in psychiatric clinics, endocrine clinics and diabetic clinics.
The average GP, he said, referred about 190 patients a year. This resulted in a total of 600 follow-up appointments.
He said consultants "effectively decide that they are taking over the long-term care of the patient. They are doing it probably because they believe, wrongly we would say, that in general practice we are not capable of delivering quality care to chronic patients."
Dr Boland said the cost of financing the health system was ever-increasing - from a budget of £1.5 billion in 1990 to £3.5 billion this year.
"This is not just something happening in Ireland but we are doing it on an unprecedented scale in terms of the rate of increase. We are only getting away with it because our GDP is also increasing so rapidly and we are managing to keep it at the same level.
"However, if we hit a recession we will be in enormous difficulty."
There was no justification for this sort of spending, he said. "There have not been any new diseases, not deterioration in the health of the population to justify this. On the other hand there has been no evidence of a vast improvement in the health of the population."
Dr Boland said that a number of patients were being unnecessarily referred to hospital for tests. He proposed that a system be introduced where GPs were given a budget for the year for certain procedures and if they came in under budget they should be given the money for investing in their practice.
A similar scheme existed for doctors to reduce their level of prescribing to medical card patients.
"I don't think anyone knows how many of these referrals are strictly necessary, but the numbers being referred are growing enormously.
"neither GPs of patients have any idea of the cost of the referral," he said.
He said the demand for health care was being "controlled" in three different ways at present - waiting lists, lack of personal care by specialists and poor physical facilities.
Dr Boland also said that continuous assessment of doctors' performance was inevitable.
The medical profession had to prove that it could be self-regulating.
"To be credible and effective recertification most focus on actual service performance. But it must also encourage excellence and improve rather than destroy professional morale."