Sir, – It is not surprising that the Taoiseach is seeking fewer GP referrals into overcrowded hospitals. As a GP himself he is someone who knows only too well the problems in primary care and in the hospital service. (Varadkar seeks fewer GP referrals to hospital, December 12th)
One of the key problems is the out-of-hours GP service. Established GPs are reluctant to do night call and so their practices contract out the on-call work at night and weekends to locum agencies. Frequently the doctors in these agencies have no long-term loyalty to the practice they are covering, have no access to the patient’s medical records and have little or no immediate access to diagnostic facilities such as ultrasound, X-rays or blood tests.
In addition they have poor nursing, physiotherapy, occupational therapy and social worker support when they try to look after a patient at home. Finally, they are worried about the litigation that might ensue in the face of these inadequacies if there is a poor patient outcome.
Therefore, as a default measure, when in doubt, they understandably send the patient to hospital, where they are admitted by a junior doctor, again frequently with poor backup and with fear of litigation if he discharges the patient back home.
None of the issues described above is of recent origin. They started about 30 years ago when general practitioners stopped managing their patients 24-7 and changed to an office hours service without backup facilities being put in place.
As a GP, Dr Varadkar knows what to do. Only when the Government puts money into primary care services will we reach a situation where patients can be looked after at home. All that is needed is a government that has the will to make the change, and the ability to find the money necessary to fund that change. Governments have failed to date, but hopefully with a Taoiseach who understands the problem, change will take place soon. – Yours, etc,
Dr TOM O’ROURKE,
Retired medical
practitioner,
Gorey, Co Wexford.