Analysis: The escalation in tension is about medical card eligibility, writes Dr Muiris Houston
"Medical card bill comes to 300 million euro" and "Revealed: GPs' Medical Card Gravy Train" were the headlines over the lead stories in two of yesterday's broadsheets.
Coming days after a very public disagreement between the president of the Irish Medical Organisation (IMO), Dr James Reilly, and the Minister for Health, Mr Martin, over eligibility for the medical card scheme, family doctors contacted by The Irish Times yesterday were in no doubt the stories represented the Minister's response to last week's row.
"I thought we had moved on from that type of spin" one GP said in reference to the more even handed reportage of doctors annual earnings that had emerged in recent years.
It has always been a bone of contention between the medical representative organisations and the Department of Health that doctors' gross practice income, which includes the salaries of other doctors and ancillary staff, had been portrayed as a named doctor's individual net earnings.
One of last year's top earners, who did not wish to be named, took The Irish Times through his accounts yesterday. With a gross payment of over €400,000 attributed to him, he pointed out that this figure included the earnings of three full-time doctors. In addition, the practice employs a practice manager, practice nurse, and two full-time secretary/receptionists.
His overheads, including rent, equipment and salaries, represented over 50 per cent of gross income. In fact, he was surprised by the Payment Board's figure, which was in excess of gross annual earnings as calculated from recent monthly credit transfers from the GMS.
"I suspect that a 2½-year backlog of payments for patients in nursing homes has inflated the figure," he said. The doctor also pointed to special payments for asylum-seekers and inflated payments for the "over-70's" deal as reasons for his higher than expected figure.
"People have to remember that the actual cost of providing cover for the average patient on a 24-hour basis represents very good value for money," he said. It is a point echoed by Dr Reilly, who referred to the Deloitte and Touche report on value for money in the health service which said the GMS scheme represented real value. But the real issues behind the latest escalation in tension between the Minister for Health and doctors concerns reform of the primary care system and the extension of medical card eligibility to a greater percentage of the population.
At both the IMO and the Irish College of General Practitioners a.g.m this year, it was clear doctors were determined to draw attention to the widening gulf between the haves and the have-nots in society. There is particular concern at research which shows that for a person just above the eligibility limit for a medical card, a visit to a GP and a subsequent pharmacy bill consumes 40 per cent of their weekly income.
Combined with a drop in those with medical cards from 37 per cent of the population to 29 per cent since the advent of the "Celtic Tiger", doctors will no longer keep quiet about the inequalities apparent in everyday practice. Many patients simply cannot afford the basic medication designed to prevent chronic illness such as asthma.
The Minister undoubtedly made a mistake by choosing to hold last week's press conference outlining "progress" with the primary care strategy. With seven of the 10 pilot schemes pretty much dead in the water and a clear failure to fund even these to a level outlined in the strategy document, never mind expand the strategy nationally, it was always going to be a potentially fraught occasion.