GPs see first hand the problems health reforms have caused
THE country's doctors fully support reform that is in the best interest of patients.
As the representative organisation for more than 90pc of general practitioners here, the Irish College of General Practitioners has often called for more resources for primary care.
The cynical often complain that we are serving narrow self-interest.
But self-interest is not what comes to mind when we see the impact of the removal of Discretionary Medical Cards from patients on a daily basis.
The Government has set a deadline of 2016 to provide free universal healthcare for everyone. Improving access to healthcare is a good thing.
We argue funding should be driven by patient need above all else, but looking at the recent changes in the medical card system, particularly in Discretionary Medical Cards, patient need cannot be said to be the impetus for change.
We are told that the criteria for granting discretionary medical cards has not changed. However, this contradicts what GPs are witnessing on the ground.
The HSE's own figures confirm that there are 10,400 less discretionary medical cards this year than in 2012.
That's more than 10,000 people who now receive no medical assistance from the State and yet people continue to be newly diagnosed with complex and severe medical conditions.
The GPs' experience of the complex problems created by this reduction in discretionary medical cards is in some cases truly shocking.
It ranges from the removal of medical cards from families where a child aged over six has a serious medical condition, to elderly patients struggling to meet payments for monthly medications.
GPs countrywide can describe situations where families are really struggling to provide necessary medications, and older people, in constant pain, are just "going without".
One GP reports that a patient, recently diagnosed with motor neuron disease, had an application for a discretionary medical card turned down.
He was informed on querying this, that if he could provide a consultant letter confirming that his condition is terminal, then he would have a better chance of having his application accepted.
We refuse to believe this is standard practice in the assessment of medical need in Ireland, but it does highlight the difficulties some patients are facing when they come to renew their existing card. Free GP care and universal health insurance represents an opportunity to completely reform the health of the nation like never before. But a GP Visit Card is not equivalent to a Medical Card.
Taking away medical cards from those who need it most to provide universal GP Visit cards can only be funded through the reduction of the population covered by full medical cards.
As a result, 35,000 people over 70 will have their level of state medical cover reduced to a GP visit only card.
This will save the HSE an estimated €25m. Has there been any estimate of the health impact of this decision?
How many of these people have private medical insurance? How many are on a range of medications? What are their medical needs? If they fail to buy their medication owing to financial pressures, what will be the impact on emergency room attendances?
GPs are driven by evidence-based medical practice. We operate with clear guidelines to structure patient care. We know what improved care looks like, whether that is controlled blood pressure, cure from infections, stable well-managed diabetes, timely diagnosis and referral where necessary.
This kind of change, requires engagement with those who are qualified and trained to provide care.
We would like to see real engagement from the Health Minister and HSE on our common goal of caring for patients and improving the health and wellbeing of our communities.
Kieran Ryan is CEO of the Irish College of General Practitioners