Sir, - For years the Irish Medical Organisation and the Government have been locked in a Faustian deal that has adopted an industrial relations approach to the provision of GP services to the poorest third of the population.
This led to the exclusion of the GP from any real input into the development of a healthcare system that is now centralised, stagnant and increasingly expensive. Meanwhile, the money I gave to the St Vincent de Paul Christmas appeal is coming back to me as professional fees. Twenty-five per cent of middle-aged male patients in my practice put off going to see the doctor because they cannot afford it. This is in an area recognised to have some of the highest rates of cardiac and respiratory diseases in Ireland.
Maev-Ann Wren (The Irish Times, February 6th) has reported Dr James Reilly of the IMO as willing at least to disturb the pay and rations approach to primary care by considering other funding options, including an insurance-based approach and a salaried GP service. In modern financing terms our primary care system is considered to have most if not all of the faults of a system that will never work, with its combination of cash-in-hand, capitation and fee-per-item payment systems.
There are some good international models available to examine and adapt for ourselves. However, we remain incurious, preferring instead to find reasons why they won't work here rather than experimenting with providing fair and competent care to everyone on the basis of need.
I have now started asking patients if they are on the electoral roll and many agree with me that voting might help their health much more than asking me to intercede with yet another letter to yet another service just as underfunded and overwhelmed as my own. - Yours, etc.,
Dr Tom O'Dowd, Professor of General Practice, Trinity College, Dublin 2,