Five GP practices received more than €300,000 each through the General Medical Service (GMS) payments in the Mid-Western Health Board region last year, figures released yesterday reveal.
The list released by the health board in response to a Freedom of Information request from The Irish Times shows a further eight GP practices received amounts between €250,000 and €300,000 in the mid-west.
In all, 156 GPs participating in the scheme across the region received more than €24.5 million in 2002 - nationally, the overall figure paid last year to GP practices was €282 million.
According to the Mid-Western Health Board, Dr Edmund O'Callaghan of Bruff, Co Limerick, was the largest recipient, receiving €326,145 in GMS payments.
Other practices to receive payments of more than €300,000 were Dr Thomas K. Curtin, Rathkeale, Co Limerick, receiving €321,724; Dr Michael Kelleher, Lahinch, Co Clare, €320,009; Dr Margaret Lonergan, Thurles, Co Tipperary, €319,383, and Dr Michael Cleary, Hospital, Co Limerick, €310,236.
The figures also show that another 20 practices received between €200,000 and €250,000, while a further 43 received between €100,000 and €200,000.
The payments by the GMS (Payments) Board to the GP practices are made to allow those on medical cards under 70 years of age to avail of a free general medical service.
The vice-president of the Irish Medical Organisation (IMO), Dr James Reilly, said yesterday that the GMS payments to GP practices could be misleading.
"A number of the practices will include two and three doctors, while the cost of secretaries, nurses and insurance has also to be covered." Dr Reilly, who is also chairman of the IMO's GP committee, said there was a crisis in recruiting and retaining GPs.
In the Mid-Western Health Board region, the GMS list shows that of the 15 largest recipients in the scheme, nine practices were based in rural areas.
"Doctors in rural areas have extremely large lists, work very long hours," Dr Reilly said, "and can find it hard in locating locums. When they do it can cost €2,000 a weekend, while it is also a strong element of GPs being married to their practice and for many, that is not a lifestyle that is attractive."
For urban-based GPs, the cost of providing services was a continuing problem, according to Dr Reilly. "In the Northern Area Health Board region, the ratio of GPs to people is one to 2,500. The national average is one to 1,600, while the recommended ratio is one to 1,200.
"It is no small coincidence then that the two hospitals in Ireland facing most difficult in A & E and crisis management, Beaumont and the Mater, are based in the Northern Area Health Board region where the ratio of GPs to patients is very high."
To address the shortfall in doctors in urban areas, Dr Reilly said there was a strong argument for putting in place an urban weighting in the GMS system, which would allow for greater pay for urban-based doctors to take account of property prices and higher wages costs.
"There is already such a system in place in the UK. We have to think outside the box and be innovative to address the situation."
