Paying to see your Doctor

faceman

Mods, please feel free to move this thread if you feel it is better suited elsewhere.

On the radio this morning, a doctor was being interviewed and he commented on how one third of GP's in Ireland are due to retire within the next 10 years and while, there is no shortage of doctors (???), there will be a shortage of GP's. He went on to say that there ideally should be 1 doctor to every 1,500 people living in his region.

He then went on to say that personally he sees 14-16 patients per day which he would describe as ranking medium tier in terms of business.

It got me thinking. While some of those patients are medical card holders, potentially he is earning pre-tax €800 per day. Thats not a bad days work!
However he is charging that to people regardless of their income, social status etc.

My question for discussion is this. At what point this it become slightly immoral, as such, for charging for GP services?

Im sure its an age old argument among the medical community. Im not looking to have a swipe at doctors either, far from it. I would like however to see some discussion around it and opinions on whether a tiered medical structure would work etc.

derek27

His earnings are well deserved, but are nothing like €800 per day... there are enormous costs associated with maintaining a general practice... nurses and receptionists salaries to state some of the more obvious.

tallaght01

I think we would have to go a long way before it becomes "immoral" for a GP to charge patients.

The government in Ireland has elected not to pay for primary healthcare (with the exception of medical card holders) and has, essentially left it up to private enterprise.

GPs are running a private business. It's as immoral for them to charge for healthcare as it is for a supermarket to charge for food, I guess.

A lot of money comes into GP surgeries. But a lot goes out, in particular in terms of salaries, insurance, and the cost of the premises themselves.

They do, however, earn good salaries, like many highly skilled professionals in ireland nowadays. They're also compensating for years of being poorly paid in hospital medicine. This particularly applies to the older GPs.

I don't think they charge much more than lawyers, for example.

It does, however, sadden me that primary care is often only available to those who can afford it. I don't think that's the fault of the GPs though.

PoleStar

This is why doctors get a bad rep, people dont do the math properly

If we take it he DOES make 800 per day (which he will not due to medical card patients), thats approx 16,000 per month.

Mortgage on premises=2000 per months (if lucky)
Nurse Salary=2800 per month
Secretary Salary=2000 per month

Other costs include medicolegal insurance, medical equipement, cleaners bills, ESB, heating, cost of car for call outs.

So as you can see, its not all that great. A regular GP is doing well if they make 90000 per year. Which while a good salary, I think is very well earned based on responsibility.

To give a reference, a prison officer with overtime will make 70,000 per year, this is after a few weeks training only, no degree or post graduate exams totalling approx 12 years in total training from leaving school.

Doesnt seem so high now does it?

BTW I am not a GP ranting!

Chunky Monkey

Just reading this thread has reminded me of a lot of questions I have but I'll stick to the one theme for the moment (though slightly off the topic of the thread my apologies). What happens if an elderly person becomes dependent and has no relatives and no money, do the state look after them by placing them in a nursing home and paying for their care and possible trips to hospital (inc. transport and care) etc? Are the elderly automatically entitled to a medical card? If so what age is considered elderly, retirement age?

eth0_

I am torn on the idea of paying for primary care. Having grown up in N. Ireland and seen how fantastic the NHS is, yes it is a wonderful invention but it also shoots itself in the foot by being free.

Example: waiting in A+E on a Saturday for 6 hours to be seen, with a huge amount of other people around me who, quite frankly, shouldn't have been there. They should have been at their GP. But its Saturday. The GP is closed. Going to the hospital is free.

So doctors are wasting their time assessing and treating people with illnesses they shouldn't have to deal with in A+E.

The same goes for GP surgeries. People turning up with flu and demanding antiobiotics etc. Can you imagine how bad that would get if you didn't have to pay 50 euro?

Chunky Monkey

Going to A+E isn't that much more expensive than going to your GP though is it? So people will go here as well if the surgery is closed on Saturdays (don't know if it is).

BanzaiBk

A&E charge is €66 as from January 08'.

Chunky Monkey

Ye I know was working there today. Still not significantly more than €55 for GP visit.

BanzaiBk

Chunky Monkey wrote: »

Ye I know was working there today. Still not significantly more than €55 for GP visit.

lol, fellow A&E worker ftw:)

Chunky Monkey

Heyo You a nurse?

Sugar Drunk

I don't mind paying a GP €55 or so for a consultation but know of some who charge this fee even if you are just getting a cert or a repeat prescription which I just wouldnt pay. Thankfully my GP changes €40 for a consultation and then about €20 for a cert/script

BanzaiBk

Chunky Monkey wrote: »

Heyo You a nurse?

No, I'm the pesky admin staff looking for the €66 off people:p

N8

tallaght01 wrote: »

I think we would have to go a long way before it becomes "immoral" for a GP to charge patients.

I agree they deserve to be well paid for what is often a thankless and stressful job.

tallaght01 wrote: »

GPs are running a private business….. A lot of money comes into GP surgeries. But a lot goes out, in particular in terms of salaries, insurance, and the cost of the premises themselves.

Are the premises not either government provided or heavily subsidised ?

PoleStar wrote: »

Other costs include medicolegal insurance...

Doesn’t the government cover this too?

Bottle_of_Smoke

PoleStar wrote: »

This is why doctors get a bad rep, people dont do the math properly

If we take it he DOES make 800 per day (which he will not due to medical card patients), thats approx 16,000 per month.

Mortgage on premises=2000 per months (if lucky)
Nurse Salary=2800 per month
Secretary Salary=2000 per month

Other costs include medicolegal insurance, medical equipement, cleaners bills, ESB, heating, cost of car for call outs.

So as you can see, its not all that great. A regular GP is doing well if they make 90000 per year. Which while a good salary, I think is very well earned based on responsibility.

To give a reference, a prison officer with overtime will make 70,000 per year, this is after a few weeks training only, no degree or post graduate exams totalling approx 12 years in total training from leaving school.

Doesnt seem so high now does it?

BTW I am not a GP ranting!

And at leat 12.5% in taxes, quite possibly 41%

microgirl

N8 wrote: »

I agree they deserve to be well paid for what is often a thankless and stressful job.



Are the premises not either government provided or heavily subsidised ?



Doesn’t the government cover this too?

I'm not a GP - or any kind of doctor - so I may be wrong but, eh, no!

F'rinstance, my GP ran his surgery in a converted garage/granny flat off his house. Ain't no government paying the mortgage on that! And you can be pretty damn sure the Government aren't paying their insurance either. For hospital/public clinic docs maybe (Probably? Definitely?) but for a GP I really don't think so. Again, could be wrong (about the insurance at least - I know I'm not wrong about the premises) but I'm relatively sure that a GP is technically self-employed. Signing up to take medical card patients may make a difference, though I don't know what difference, but otherwise they're on their own afaik.

Esel

N8 wrote: »

Are the premises not either government provided or heavily subsidised ?

Doesn’t the government cover this too?

How the fup did you think that?

Moriarty

Do GPs have contracts with the HSE(/any other part of government) or can you just set up your own practice wherever you like and have it open for as long as you like once you have the qualifications?

It's a pity we don't know more about the health service in general here, it might lead to more informed debate.

N8

esel wrote: »

How the fup did you think that?

Hospital consultant insurance is covered (Obs/Gyn insurance is almost if not over €100K pa.)

The medical centres seen in Ireland are built by the government and as I understood it a very reasonable rent is paid by the GPs operating from these centres.

This is how I came to think it. Perhaps a GP here would elaborate.

tallaght01

my understanding of it is that GPs are self employed, and pay all their own costs.

Their insurance defnitely isn't covered by the govt.

Even consultants insurance isn't covered by the govt, as far as I know?

I'm not a consultant, but have always paid my own hospital insurance. Are most consultants not members of a defence body?

The medical centres that N8 is referring to are, I think, the ones with usually a dentist/pharmacy/GP/nurse etc. These were predominantly in areas where they couldn't attract these services easily, becauuse they're rough as hell, and most patients were medical card holders, so they were less profitable. So they let a GP/dentist/pharmacist lease the various bits of the medical centre at good rates. The GP doesn't own any part of the centre though.

But as far as I know your average GP is self employed in apoxy helf converted house on a residential estate. Coming from the UK system, I do find it a strange way to practise medicine.

As far as the medical card situation goes, not everyone is entitled to see medical card holders.

There are a certain amount of "General medical services" numbers available. If a GP has one of these numbers, they can see medical card patients and get reimbursed. GPs apply for these, when they become available, which I think involves waiting for an existing number holder to retire.

tallaght01

As an aside, I've just paid a GP 210 euro for a quick medical this week, for my ozzie visa.

And that was with a 50euro discount!!! Ouch
I'm definitely wasting my time in neonates!

eth0_

N8 wrote: »

Hospital consultant insurance is covered (Obs/Gyn insurance is almost if not over €100K pa.)

Jaw....floor....


:-O No wonder the consultants want a better pay deal! Lovely how our newspapers conveniently never mention the cost of consultant insurance in this country - sure doctors are a bunch of bad guys on megabucks :rolleyes:

btw couldn't it be seen as a conflict of interest if hospitals paid their consultants' insurance?

ergo

Moriarty wrote: »

Do GPs have contracts with the HSE(/any other part of government) or can you just set up your own practice wherever you like and have it open for as long as you like once you have the qualifications?

It's a pity we don't know more about the health service in general here, it might lead to more informed debate.

As soon as a doctor graduates and completes his/her intern year then he/she is fully registered with the medical council and can put a name plate outside the door/any door/garden shed and see private patients as a GP.

But, in order to be able to see public (medical card) patients a doctor needs to get a contract with the HSE for a GMS (General Medical Sevices) list. To be entitled to apply for a GMS list a doctor has to be "vocationally trained" that is to say complete the recognised GP training which roughly equates to 2 further years in hospital medicine (usually rotating through A+E, Medicine, Paeds, Psych, +- Obs/Gynae, others) and then 2 years as a trainee GP in a GP practice. At the end of this 4 years the MICGP diploma is awarded so a doc can then get a medical card list. I'd say approx 40% of population at this stage are entitled to medical cards so most GP's would probably need/prefer to have a medical card list as opposed to just seeing private patients all the time, depends on location of course and anyone else feel free to correct me if I'm wrong.

For medical card patients GP's receive a fixed amount (maybe €100, maybe more - I'm really not sure) per annum from the HSE for each medical card patient they have on their books regardless of whether that patient never visits or visits 50 times per year.

For private patients it is a once off fee of whatever €50 or €55, I'm not sure, depending on what's done. When you take into account the fact that doc has trained/worked for probably at least 10-11-12 years prior to even day 1 as a GP the cost is probably fair enough but again at times might be hard to justify for a 2 minute consultation.
*Aside: my own Australia medical cost €80 back in 2003 - that's some inflation since! *

Most GP's do own their own surgeries I think but the future plan is for purpose built primary care centres with multiple GP's and allied health professionals under one roof, that's gonna take forever to happen though especially with the relative cutbacks in the past year or so.

There will be a critical shortage of GP's in the next 5-10 years (if not already) because

a) A large majority of current GP's are men in their 50's working long working weeks and all approaching retirement age and not necessarily planning to work past that!

b) The majority of current medical graduates and GP trainees are female and, at risk of being called sexist, will not be willing to work the long hours of their predecessors (and why should they?) and will be more inclined to work flexible hours, 3 or 4 day weeks etc with family in mind

c) No increase in number of GP training places (ie to get from end of intern to MICGP 4 years later). Only 121 places for the country. Soon there will be 550 plus medical graduates per year. It's going to be a disaster

d) No option of going to the UK to train. This was an option up until this year to do the hospital jobs here in Ireland and do 1 year in the UK and come back with the MRCGP and straight into practice in Ireland. The UK have done away with this and every budding GP has to train for the full 3 years in the UK and even these places are highly competitive.

e) We already have the 2nd lowest ratio of GP's to population in the EU. And we are the 2nd richest country apparently.

f) The aging population will put even more pressure on the health service as people live longer with chronic ilnesses

donaghs

tallaght01 wrote: »

GPs are running a private business. It's as immoral for them to charge for healthcare as it is for a supermarket to charge for food, I guess.

While I understand that a GP has to run a business I'm not entirely comfortable with that logic. Didn't they take some sort of oath to help sick people? The above quote seems more like something Michael O'Leary would say.

I don't believe it is immoral to charge for GP services, but to compare sick people (sometimes dying) with food shopping is an interesting one.

tallaght01

donaghs wrote: »

While I understand that a GP has to run a business I'm not entirely comfortable with that logic. Didn't they take some sort of oath to help sick people? The above quote seems more like something Michael O'Leary would say.

I don't believe it is immoral to charge for GP services, but to compare sick people (sometimes dying) with food shopping is an interesting one.

It's just a point I made because both food (as one example) and healthcare are often neccesary for people to live.

We can tolerate people not having enough money for food. Nobody ever talks about the morality of supermarkets charging for food. But people often talk about the morality of a GP charging for healthcare.

I believe in free healthcare for all, but have always thought it was an interesting comparison (it does the rounds in medical circles quite a bit), albeit pretty airy-fairy as a concept

N8

N8 wrote: »

Hospital consultant insurance is covered (Obs/Gyn insurance is almost if not over €100K pa.)

eth0_ wrote: »

Jaw....floor....

btw couldn't it be seen as a conflict of interest if hospitals paid their consultants' insurance?

Does this insurance also cover their private work ?

tallaght01 wrote: »

It's just a point I made because both food (as one example) and healthcare are often neccesary for people to live.

We can tolerate people not having enough money for food. Nobody ever talks about the morality of supermarkets charging for food.

Interesting comparison given the inflated prices charged for food in Ireland when compared to the continent (especially fresh food).

ergo wrote: »

f) The aging population will put even more pressure on the health service as people live longer with chronic ilnesses

You would think then the government would consider tax incentives for future health benefits – after all it is the most basic asset of a nation. Tax incentives to improve your health....

Chunky Monkey

They're increasing the number of places from 2009 to 725. Anybody else worried that the jobs situation might become like in the UK?

tallaght01

Chunky Monkey wrote: »

They're increasing the number of places from 2009 to 725. Anybody else worried that the jobs situation might become like in the UK?

No, I don't think so, as you'll all be working less hours as the European Working Time Directive comes in fully, so we'll need more docs to cover.

Chunky Monkey

Ah okay that's good (I think)

tallaght01

you should be fine, chunkymonkey.

I don't think the dire situation (in terms of recruitment) in the UK has found it's way here yet.

The employment problems in the UK have come from a whole raft of factors in terms of govt policy, aswell as a huge change in the recruitment process for doctors.

I still get the occasional call from a dublin kids hospital asking if i want a job, after I'd made an informal enquiry about working there 3 years ago!

What do the Irish docs on here think about employment prospects for our new graduates? Still pretty good?

eth0_

Soon there will be 550 plus medical graduates per year. It's going to be a disaster

550? How can we possibly sustain that amount of graduates, even when the working time directive comes into effect, are hospitals REALLY going to follow it?

Chunky Monkey

There's an opinion (albeit a fairly cynical one) floating around among some med students over in the UK that the reason why so many new medical school places were formed is because the governement wanted to flood the market with doctors so they would become so desperate they would take a job no matter how low the wage.

2Scoops

Chunky Monkey wrote: »

There's an opinion (albeit a fairly cynical one) floating around among some med students over in the UK that the reason why so many new medical school places were formed is because the governement wanted to flood the market with doctors so they would become so desperate they would take a job no matter how low the wage.

The government is not that smart, nor that stupid. Any med student who genuinely believes that is an idiot.

tallaght01

2Scoops wrote: »

The government is not that smart, nor that stupid. Any med student who genuinely believes that is an idiot.

I don't think that's neccesarily true, 2scoops.

I think most docs in the UK believe that the govt is purposely trying to disempower us.

They plant numerous stories in the media for eg, about how we're overpaid. Then it's easier for them to impose a 0% payrise on the GPs.

The labour govt in the uk are masters of public relations/spin.

They've taken a lot of power away from consultants. They've made junior docs so stressed about getting a job that they'll work in any location, under almost any conditions.

I voted for the labour govt when they first came into power in the UK in 1997. Now, after years of being spinned against in the media, and being treated like crap, I would have difficulty in even being in the same room as a labour politician.

It's very hard to prove, but I definitely believe that the more desperate we are for work, the more we can be manipulated. I also firmly believe the govt are actively exploiting this. It's one of the reasons I left the NHS.

ergo

eth0_ wrote: »

550? How can we possibly sustain that amount of graduates, even when the working time directive comes into effect, are hospitals REALLY going to follow it?

I think it's going to be a complete disaster

I mean this current year there have been stories about the difficulties some medical graduates have encountered trying to secure intern jobs and that there are according to the IMO approx 100 graduates from Irish medical schools forced to go abroad each year because of the lack of intern posts.

Now, admittedly most, if not all of these 100 per year are non-EU originally (yes, the people who fund our "free" education and keep our medical schools running - sorry, no job for you, off you go back to where you came from... )

but back on topic, in recent years, even for Irish/EU graduates, it has been increasingly difficult to secure an intern job, particularly for some in certain hospitals where they may have trained but there aren't enough jobs

EWTD could potentially increase the number of posts but can anyone seriously see it doubling the number of posts...? And in such a short time.
and remember, you need to complete your intern year to be fully registered.

as regards jobs for the subsequent years well, most of the medical/surgical/GP training schemes are currently over subscribed here

add into that the number of UK graduates (possibly 3 graduates for every job there depending on who you talk to) who will hop over here, looking for jobs. And there will be some very good, very well-qualified UK graduates taking positions here, as they are entitled to.
also the Irish returning from Prague/Budapest medical schools etc, will need to be considered equally

I don't want to be a merchant of doom but I honestly don't know where all these medical graduates are going to go

tallaght01

ergo wrote: »

I think it's going to be a complete disaster

I mean this current year there have been stories about the difficulties some medical graduates have encountered trying to secure intern jobs and that there are according to the IMO approx 100 graduates from Irish medical schools forced to go abroad each year because of the lack of intern posts.

Now, admittedly most, if not all of these 100 per year are non-EU originally (yes, the people who fund our "free" education and keep our medical schools running - sorry, no job for you, off you go back to where you came from... )

but back on topic, in recent years, even for Irish/EU graduates, it has been increasingly difficult to secure an intern job, particularly for some in certain hospitals where they may have trained but there aren't enough jobs

EWTD could potentially increase the number of posts but can anyone seriously see it doubling the number of posts...? And in such a short time.
and remember, you need to complete your intern year to be fully registered.

as regards jobs for the subsequent years well, most of the medical/surgical/GP training schemes are currently over subscribed here

add into that the number of UK graduates (possibly 3 graduates for every job there depending on who you talk to) who will hop over here, looking for jobs. And there will be some very good, very well-qualified UK graduates taking positions here, as they are entitled to.
also the Irish returning from Prague/Budapest medical schools etc, will need to be considered equally

I don't want to be a merchant of doom but I honestly don't know where all these medical graduates are going to go

interesting post, ergo.

I would say, though, that there isn't one post per 3 UK graduates. There's unemployment over there, but it's not that high.

I would also ask why the EWTD won't lead to a doubling of posts? The docs in Ireland are working 80 hours plus per week, but the EWTD will reduce this to 48 hours, so they'll need a lot more docs.

I never thought about the people coming back from the Eastern European schools. Is there a lot of them? I certainly here lots more about people going over there nowadays.

ergo

tallaght01 wrote: »

interesting post, ergo.

I would say, though, that there isn't one post per 3 UK graduates. There's unemployment over there, but it's not that high.

I would also ask why the EWTD won't lead to a doubling of posts? The docs in Ireland are working 80 hours plus per week, but the EWTD will reduce this to 48 hours, so they'll need a lot more docs.

I never thought about the people coming back from the Eastern European schools. Is there a lot of them? I certainly here lots more about people going over there nowadays.

EWTD is going to be very difficult to implement fully, quickly (and I am no expert on this and haven't been following the HSE's latest take on it all)

It does sound simple in theory that if you double the number of docs and pay them all a much smaller amount of overtime then possibly it shouldn't cost much or should in fact save money

but, current work practices, in particular the resistance of NCHD's to move to 5/7 rosters ie. working any 5 out of 7 days instead of M-F, I think make the implementation not straightforward. If you add to that the proposed HSE practice of abolishing one NCHD position for every new consultant post created and also the financial tightening of the belt I can't see, all of a sudden, a glut of new junior doctor jobs being created miraculously in the next 3-4 years

However, if they can sort out the intern situation and creat an intern post for every graduate (and I don't think that is an unreasonable goal over the course of 4 years, but probably highly unrealistic in light of how long everything even simple takes to happen in the Irish health service) there would be jobs for everyone at the end of it as SHO's/REG's

but a lot of Irish graduates would be forced out of the major teaching hospitals and the major cities to work as SHO's/REG's in the smaller hospitals currently staffed (in the majority of many small hospitals) by non-EU doctors. And if these jobs aren't approved for training, people may look elsewhere ie. the US or Australia

Dunno about the numbers of Irish training in Eastern Europe but there are a few, and, while previously there may have been no competition for intern jobs, now these people are coming back and competing and obviously have to be considered just like everyone else

tallaght01

ergo wrote: »

EWTD is going to be very difficult to implement fully, quickly (and I am no expert on this and haven't been following the HSE's latest take on it all)

It does sound simple in theory that if you double the number of docs and pay them all a much smaller amount of overtime then possibly it shouldn't cost much or should in fact save money

but, current work practices, in particular the resistance of NCHD's to move to 5/7 rosters ie. working any 5 out of 7 days instead of M-F, I think make the implementation not straightforward. If you add to that the proposed HSE practice of abolishing one NCHD position for every new consultant post created and also the financial tightening of the belt I can't see, all of a sudden, a glut of new junior doctor jobs being created miraculously in the next 3-4 years

However, if they can sort out the intern situation and creat an intern post for every graduate (and I don't think that is an unreasonable goal over the course of 4 years, but probably highly unrealistic in light of how long everything even simple takes to happen in the Irish health service) there would be jobs for everyone at the end of it as SHO's/REG's

but a lot of Irish graduates would be forced out of the major teaching hospitals and the major cities to work as SHO's/REG's in the smaller hospitals currently staffed (in the majority of many small hospitals) by non-EU doctors. And if these jobs aren't approved for training, people may look elsewhere ie. the US or Australia

Dunno about the numbers of Irish training in Eastern Europe but there are a few, and, while previously there may have been no competition for intern jobs, now these people are coming back and competing and obviously have to be considered just like everyone else

I think they're going to have to move to the system that a lot of countries use, whereby you do things like nights in blocks.

For eg, one intern/SHO/reg all do a week of nights together. They have no daytime commitments at all during that time. They receive all new admissions, and go on the ward round next moring with the receiving team, and hand the patients over. The patients are then under the care of the receiving team. There's arguably, less "ownership" of your patients in this case, and it can make care a bit disjointed but it works reasonably well in other countries.

Then you have one intern/SHO/reg on receiving duties for a long day. Again, they're not neccesarily from the receiving team. They might do one long receiving day per week, or a block of 7 in a row every few weeks.

I agree that the current rostering setup won't survive the implementation of the EWTD.

I also think nore exposure to the regional hospitals will be good for people. I remember feeling aggrieved when I was put out in the backarse of nowhere, as part of my SHO rotation. But it was a great learning experience. It's of great educational value, in that you're not neccesarily handing patients over to the specialties the moring after they're admitted

I also find it strange that there won't be a new NCHD for each new consultant appointed under the new contract. I'd heard rumblings about this, and lack of clerical support staff too. Has that all not been sorted?

robinph

I have absoloutly no problem with GP's getting paid a decent amount of money for whatever number of patients that they happen to deal with. What I do have a problem with is the need for them to be taking cash off the patient at the time of the medical service being given, there being financial transactions going on at that point is just wrong. Charge more tax or prsi or whatever to pay for it, but the patient should never have to be handing over cash for required medical services at the point of needing them. Unless they are choosing to go private ones ability to pay should have nothing to do with receiving medical care.

Some time last year I was stuck in the UK for a month or so and during that time then ended up running short of my various medications so popped along to see the local GP there to get a prescription. One of the items that I usually got was changed during this visit though as it turned out it wasn't actually the right one that I was on at the time. This was never picked up by any GP in Ireland as it had initialy been put on my prescription due to a change in manufacturer but as there was never anything additionally wrong with me since then so I don't bother going along to a GP again for a checkup and to pay them €50(?) to be told that I'm perfectly fine, which I already know anyway.

The UK GP wrote a letter to the Irish GP saying what they had changed and why, I then have to go along to the Irish GP and get him to re-write out my repeat though but I then get charged €50(?) for him copying out what another GP had told him. I should be visiting a GP reguarly to check that I'm still on the correct medication, but I cannot bring myself to pay to do that unless there is actually something new wrong with me to justify the visit.

The prescriptions in the UK were all completely free also due to their list of long term conditions for which you get free prescriptions being a bit larger than here.

ergo

robinph wrote: »

I have absolutely no problem with GP's getting paid a decent amount of money for whatever number of patients that they happen to deal with. What I do have a problem with is the need for them to be taking cash off the patient at the time of the medical service being given, there being financial transactions going on at that point is just wrong. .

I hear what you're saying but unfortunately there is the business element of it and fresh air isn't going to pay for the receptionist/secretary's wages/rent/doctor's indemnity insurance etc etc. A minority of people can't be trusted to pay fees at a later date and the people who do pay up front shouldn't end up effectively subsidising these people. You only need to look at the amounts owed to every hospital in the country from unpaid Accident and Emergency dept fees, where people are given the option of paying now or paying later (and these are all people above the medical card income threshold). I couldn't find many exact figures but last year Kerry general Hospital was owed €527,288 in unpaid A+E fees. Some of the Dublin hospitals were owed millions.

On the other hand I presume some GP's are more relaxed about it in terms of fee collection. Either way, nobody is going to be refused treatment that they need if they can't afford it there and then.

With regard to the transcribing of a prescription from a UK doctor, well I'm not sure if most GP's could justify charging the full whack for that, nor do I know what most GP's would do in that situation, I'll make some enquiries. Your own GP will probably take what the UK doc's letter says into account and then separately review the need for each and every one of your meds before issuing a further repeat prescription. As your own GP will be issuing the prescription (even though the UK doc did it originally) your own GP will be ultimately responsible for the effects/side-effects so it's in his/her interests to make sure it's appropriate/safe etc.

Access to doctors and financial deterrents from visiting them are massive problems in the world of GP here. You end up with some medical card patients going to their doc's inappropriately every week and some people (like yourself) above the medical card threshold waiting 'til they are sick sick before justifyng the expense of a GP visit. Hard to know where the solution lies.