There are currently 170 personal doctors in Gesy with 2,500 registered patients each. In other words, 170 personal doctors are looking after a total of 425,000 patients. Is it possible for a single doctor to be able to provide a reasonable standard of primary healthcare for 2,500 patients, be aware of each one’s medical history and offer advice on preventive care?

This does not seem practically feasible and many deputies questioned this arrangement at a meeting of the House health committee, which discussed Gesy. All agreed that there were weaknesses, distortions and mistakes that needed to be addressed by the Health Insurance Organisation (HIO), while some deputies expressed the view that the number of patients per personal doctor had to be reduced. This can easily be done considering there are 640 personal doctors.

The health committee also referred to the report prepared by the World Health Organisation on ‘Strengthening primary healthcare and reducing over-provision of low-value specialist care.’  The HIO has been concerned about the problem of an excessive number of referrals to specialists by personal doctors, who have not been performing their primary role, as gatekeepers to Gesy.

They should be signing referrals only when there is a real need instead of doing this liberally and cluttering up the system. Personal doctors often come under pressure from a patient to sign a referral and easily give in as it reduces their workload, especially when they have 2,500 registered patients, and passes on the responsibility of treatment to another doctor. But if a patient needs four or five months to see a specialist, when they can be treated immediately by a personal doctor they are putting their health at risk.

When Gesy was first set up, the maximum of 2,500 patients per personal doctor may have been necessary, but because of the generous remuneration €100 per patient per year, regardless of whether a patient sought healthcare, many medics registered as personal doctors. The HIO believed that with more personal doctors joining Gesy the patients would become more evenly distributed, but this does not appear to have happened.

The high rewards for personal doctors has led to many doctors leaving public hospitals, despite the sizeable pay rises they received, and they now face many shortages, especially at A&E departments at which work is much more taxing.

These are matters that must be addressed now. First, the maximum number of patients registered with a personal doctor must be reduced. Second, the remuneration of a personal doctor must be linked to the number of patients he or she actually sees. Third, for a doctor to be registered as a personal doctor, they must be required to undergo training, at least for a few months, as a GP – this could also reduce the inordinate number of referrals.

It may be difficult to bring about these changes, but the HIO must take advantage of the consensus that exists about the need to upgrade primary care.