UK primary care is a victim of its own success, warns GPC leader

Soaring demand for GP consultations far outstrips need and has left UK general practice struggling to cope, Northern Ireland's top GP has warned.

Dr Tom Black: concern over rising patient demand
Dr Tom Black: concern over rising patient demand

GPC Northern Ireland chairman Dr Tom Black made the warning following a row in the Republic of Ireland - where patients pay to see their GP - over the threat of an imposed contract that would bring in free consultations for children under six years old.

Writing in the Sunday Business Post, published in the Republic, Dr Black said UK general practice had become a ‘victim of its own success’ with rising demand and must redefine need.

‘A free GP service is an absolute boon to the community,' he wrote, ‘but, unfortunately, it causes increased access as people forget how to care for themselves.’

Doctors’ leaders in the Republic of Ireland have warned that moving towards free access without more funding would increase demand.

A compromise deal could look at co-payments or personal health budgets, suggested Dr Black.

‘The other risk associated with a free GP service,' he said, ‘is that GPs spend so much time looking after the worried well and their demands that it means there is less time to see sick patients with greater needs.’

‘How do you limit access to a service which people really value, and where public knowledge and experience is limited so that failure to access a service could carry a risk to your health?’

People usually limit their access to services due to cost, he said. ‘Without a cost hurdle in healthcare, and with limited knowledge, public demand escalates.’

‘How can society deal with these dysfunctional dynamics? We want easy access for healthcare, but we don't want it used irresponsibly.’

Dr Black suggested greater health promotion and self care could help manage increases in demand but would not reduce existing demand.

Use of co-payments with exemptions for vulnerable groups, or individual patient budgets could be used, although both solutions have disadvantages, he acknowledged.

Dr Black told GP his comments about charges related only to the Republic of Ireland. The BMA is strongly opposed to charges in the UK health service.

‘The problem in the Republic of Ireland,' Dr Black told GP, 'is a huge recession, lack of GP funding and the situation where people already pay for GP consultations and prescriptions. Given that context I was simply saying there are options they could look at. For instance those options used by socialist governments in northern and central Europe.’

Consultation rates in Northern Ireland are double those in the Republic, said the Derry GP, while mortality and morbidity rates were the same.

‘So it would appear our provision of healthcare is much more demand than need. If that is what the public and politicians want and they are prepared to pay for it, that’s fine,' he said. ‘In the Republic of Ireland, in a much more constrained financial environment, I think they would have a very difficult time doubling GP consultation rates and being able to afford it.’

Concluding his column in the Sunday Business Post Dr Black wrote: ‘We cannot ignore the blind collusion between the public, politicians and the professions that ignores the reality of the impending healthcare crisis and perpetuates the myth that demand equates to need. We have to be clear about our priorities, and ensure that with patient rights come responsibilities.

‘The NHS promised a comprehensive service funded by taxation, available to all and free at the time of need. This is the fairest, most efficient and most effective way of looking after our community, but our experience shows that society needs to redefine what need is, and whether comprehensive really does mean ''everything you want".’

In an interview with GP to be published on 3 March Dr Black said patients in Northern Ireland had benefited from the UK model of healthcare compared with the expensive charges over the border. The 'obvious option’ of charging to manage demand, he said, would be politically 'unpalatable' in the UK.

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