It’s not unnatural that we in Ireland looks towards bigger neighbours for example
In most assessments of the best countries in the world in which to live, we are mostly pointed in the direction of Scandinavia – a model we are encouraged to follow – with their excellent healthcare services, good environmental standards and family-friendly work practices.
The UK is another nation we might be inclined to follow – given that we have so much in common. In truth, we resemble the British more than anyone else – indeed, many of the ‘British’ are Irish if you go back a generation or two.
But if we copy the British in terms of what they have done to primary care, we will be making a terrible mistake, and doing a ‘Truss’ – or a ‘huge, damaging, stupid action which will have negative consequences for many people for years, if not decades’.
The BBC coverage of the shortcomings in GP care in the UK have illustrated not simply how bad that service has become, but also how easily people fall through it. It also showed how telephone conversations and video conversations are not the same as meeting a person, in person.
You all know it. Given enough time and enough tests, you’re almost certain to come up with a proper diagnosis. Given enough time and enough tests. When you’re trying to make a practice work without the resources it needs, you’re going to make errors.
It’s not a matter of how good you are as a doctor. It’s not a matter of well you triage patients and maximise the use of your time, and the time of other healthcare workers. Once you go past a certain point, you’re just not as good as you were when you started, due to tiredness and fatigue.
This works in all areas of the health service, which, in any case, is all connected up. A shortcoming in one area will, sooner or later, manifest itself elsewhere. Overload GP services and you’ll just end up with more people at the ER. Make doctors work impossible hours, and you’ll have less doctors due to burnout.
We have only to look across the water to the UK to see how badly things can go by following ideology to its logical conclusion. Sadly, the UK seems to be in the grip of a right-wing cabal that first pushed the whole country down the Brexit road, and now seems intent on further enriching the super-rich, while saddling the poor and middle-classes to decades of future debt.
This is done in the name of ideology – pushed by lobbyists for big business and wealthy individuals – many of whom have no interest in the ‘common good’. But the ‘economy’ is made up of millions of economic units, and those units want to be able to see a doctor, heat their homes and buy the occasional bit of food. Ideologies that build economies while ignoring these essentials are what gave us famine in Ireland in the 19th century and they are as evil now as they were then.
But before we congratulate ourselves on not falling down the far-right rabbit-hole, we should remember that we often follow the British example – thinking them to be far ahead of us, which, medically, is often the case. It was the case for so many years that now, we almost tend to do it by default.
But even if we did give tax cuts to the very rich, and even if that (somehow miraculously) stimulated the economy and growth, I wouldn’t want to live in that society, and I suspect most Irish people wouldn’t either. Even if you win the rat race, well, you’re still a rat!
It is far better to attempt to give everyone a shot at being a full economic unit, or human, as they’re sometimes called, and that means that occasionally, they will need access to a GP. And this is where the Budget has given general practice a ‘hospital pass’. (For non-Rugby types a ‘hospital pass’ is one where you are about to be tackled, but instead to pass on the ball to someone who is even more vulnerable and the resulting pile-on results in that person being ‘hospitalised’).
General practice cannot possibly deal with the increased workload that will come with 430,000 extra GP-visit cards. What will happen is that it will cause waiting lists, and then – as a frustrated GP admitted during that BBC programme – the squeakiest wheel will get the grease. In other words, the aggressive patient, the naggers, the constant callers will get attention while the older, sicker, needier person is left to wait.
It’s depressing. Especially given that this is exactly the kind of move that has traditionally placed doctors at odds with the public and in a no-win situation. If GPs oppose this move, they are refusing to see patients who now expect to be seen. If they agree to it, they will be swamped.
And yet, this is the moment when a major shift in general practice is possible. GPs now have a weapon in that the government has announced this measure, but does not have the agreement with GPs to enforce it.
It won’t do any harm (to patients) sitting on a shelf. It will if doctors agree to it. They must not. They must summon up their best Nancy Reagan imitation and ‘Just Say No’.
This is the time to push the case for a proportionate increase in the number of GPs, GPNs and allied staff in primary care. The argument is clear, and it is one the public will support – piling a workload on GPs will not create efficiencies or help people. It will hurt people.
And if not now, when?
Finally, the medical profession has a weapon. It can say – with good reasoning – that it will not introduce this measure, or any other, until the resources are provided to ensure that medical standards are maintained, and the appropriate workforce is provided to do the work. In the meantime, everything will remain the same – overworked and bursting at the seams, but just about coping.
But to agree to this without major reform and change would be suicidal. In some cases, literally. It shouldn’t happen. Doctors should unanimously say they won’t participate until proper reform is initiated.
Your move, Minister.