HSE 'COULD save millions on drugs'

blueyedson

Taken from independant online version today:

HSE 'could save millions on drugs'
[Posted: Mon 13/07/2009 by Joanne McCarthy]
The HSE could save €100 million on nine drugs alone if UK generic medicines were used, Fine Gael have claimed.

According to Fine Gael’s spokesperson for health, Dr James Reilly TD, substituting generic medicines at the UK cost could save between €90 and €100 million euro on the state’s bill for just nine drugs.

“I have examined the cost of the top twenty most expensive drugs dispensed on the medical card scheme. Nine of these drugs have a generic form available. My research shows that the Irish taxpayer is being ripped off with Irish generics costing up to 20 times more than their UK equivalent,” Dr Reilly said.

“The state could save €90 million on these nine drugs alone if the cost of generic medicines here was reduced to the UK price. If generic medicines were substituted for all prescriptions of these nine drugs savings could climb to €100 million,” he added.

The figures revealed by Dr Reilly show that the equivalent of just €1.11 is charged in the UK for the generic ulcer drug Omeprazole. The cost of the generic drug in Ireland is €20, meaning that almost €21 million could be saved if UK prices were used here for that drug alone.

“It is abundantly clear that if these savings were expanded over the entire drugs bill hundreds of millions could be saved annually. This represents billions over the last 12 years of this incompetent Government.

“This Government thinks it’s tough when it cancels cervical cancer vaccination programmes, closes down children’s wards, means tests the terminally ill for medical cards and leaves hundreds of sick people lying on trolleys for days on end. These options are tough on people but the real tough option is to take on rip-off and waste in our system,” he added.
The other drugs highlighted by Dr Reilly which could reportedly be bought at a fraction of the current cost include Lansoprazole, Pravastatin, Pantoprazole, Amlodipine, Alendronic acid, Venlafaxine, Doxazosin and Risperidone.

Vorsprung

Did Dr O'Reilly find out why we're paying more than the NHS though - that's the real question. The price differential is truly shocking.

PS I never got why we have so many PPIs available. The trend in my old place was to use pantoprazole, but never got why it was better than something like omeprazole. I believe that the only oral PPI used in St. James' is omeprazole, and IV pantoprazole is used.

ergo

Hmm, I wonder did Dr. O' Reilly's research include reading through our "pharmasuitacles" thread ....:rolleyes: http://www.boards.ie/vbulletin/showthread.php?t=2055480689

anyway, am glad it's being highlighted - heard this story on radio 1 on the old long wave in the car here this morning

it is ridiculous the money thrown away on PPI's and statins

the vast majority of patients in NHS are given the likes of (for example) omeprazole and simvastatin (which are both cheap as chips) initially and only put on the expensive ones when all teh generics have been tried

I have a feeling it's the drug companies taking us for a ride

PS: f*ck me - generic omeprazole in Ireland is €20 - f*cking hell :eek:

Kristopherus

O'Reilly is the dodo that screwed the Health Service at every opportunity he could when he was involved with the IMO. I would'nt give a toss for his opinion.

Vorsprung

Kristopherus wrote: »

O'Reilly is the dodo that screwed the Health Service at every opportunity he could when he was involved with the IMO. I would'nt give a toss for his opinion.

In what way?

DrIndy

Kristopherus wrote: »

O'Reilly is the dodo that screwed the Health Service at every opportunity he could when he was involved with the IMO. I would'nt give a toss for his opinion.

Think this needs to be substantiated.

My issue is even if those savings are made now - think of the years that have passed when that money was not available for other services for patients of the HSE. How many hospitals/cancers ops/ nursing home beds/ physios/ots/ speechies were wasted for years?

liberal

The HSE switching to generic drugs would be like giving a very big two fingers up to multinational drug companies that are essential to Irelands economy at the moment.........it won't happen.....ever

Vorsprung

liberal wrote: »

The HSE switching to generic drugs would be like giving a very big two fingers up to multinational drug companies that are essential to Irelands economy at the moment.........it won't happen.....ever

I hear a lot of the multinationals are starting to produce their own versions of off-patent drugs which they hadn't been making before.

RobFowl

Kristopherus wrote: »

O'Reilly is the dodo that screwed the Health Service at every opportunity he could when he was involved with the IMO. I would'nt give a toss for his opinion.

DrIndy wrote: »

Think this needs to be substantiated.

My issue is even if those savings are made now - think of the years that have passed when that money was not available for other services for patients of the HSE. How many hospitals/cancers ops/ nursing home beds/ physios/ots/ speechies were wasted for years?

I believe he is referring to the fact that Dr Reilly was the GP negotiator when the over 70's GMS card was introduced. His remit was to obtain the best deal for GP's. If any one feels he failed in that role then they would be in a minority.
Also the IMO's position at the time was that extending the means testing threseholds would be a much fairer mechanism rather than the cynical attempt to bribe over 70's (who are more likely to vote and vote FF).
As we now know the same government recently removed this over 70's card.

ZYX

RobFowl wrote: »

I believe he is referring to the fact that Dr Reilly was the GP negotiator when the over 70's GMS card was introduced. His remit was to obtain the best deal for GP's. If any one feels he failed in that role then they would be in a minority.
Also the IMO's position at the time was that extending the means testing threseholds would be a much fairer mechanism rather than the cycnical attempt to bribe over 70's (who are more likely to vote and vote FF).
As we now the same government recently removed this over 70's card.

I certainly feel it was wrong and I have never met a GP who felt the over 70s deal was right for general practice. It meant huge sums of money were spent in wealthy areas and not in more deprived areas.

ZYX

ergo wrote: »

it is ridiculous the money thrown away on PPI's and statins

the vast majority of patients in NHS are given the likes of (for example) omeprazole and simvastatin (which are both cheap as chips) initially and only put on the expensive ones when all teh generics have been tried

I have a feeling it's the drug companies taking us for a ride

PS: f*ck me - generic omeprazole in Ireland is €20 - f*cking hell :eek:

A much bigger question is why do Irish doctors prescribe so much PPIs and statins. PPIs are handed out like smarties when often telling patient to take the odd rennie would be enough. When H2 antagonists came out they were hailed as a great break through. Are there really huge amounts of people for whom H2 antagonists are either contraindicated or fail to work. I doubt it. People simply go for PPIs as first line.
Statins are given to anyone with a high cholesterol without even looking at cardiac risk or without giving diet a chance.

RobFowl

ZYX wrote: »

I certainly feel it was wrong and I have never met a GP who felt the over 70s deal was right for general practice. It meant huge sums of money were spent in wealthy areas and not in more deprived areas.

+1
Extra investment into the leafy suburbs and less into deprived area's.
Any governemtn the justified a 140 fee per year for a 70 year old in Moyross (for example) and yet 700 per year for the likes of Tony O Reilly beggars belief

ZYX

liberal wrote: »

The HSE switching to generic drugs would be like giving a very big two fingers up to multinational drug companies that are essential to Irelands economy at the moment.........it won't happen.....ever

It is not the HSE that needs to change. Individual doctors should get in the habit of prescribing generically. Even if there is no generic available. If doctors took responsibility themselves for the drugs prescribed millions could be saved every year. Simply ask a few questions
1 Does this person really need medication?
2 Will patient take it if prescribed?
3 What is the cheapest class of drug that would benefit this patient?
4 Is there a generic available?

drzhivago

Kristopherus wrote: »

O'Reilly is the dodo that screwed the Health Service at every opportunity he could when he was involved with the IMO. I would'nt give a toss for his opinion.

Think that is incredibly harsh at best and slanderous at worst

IMO is a medical union, doctors involved negotiate terms and conditions with HSE for their members but just terms and conditions, not drug prices for a start

Second IMO is a professional body and negotiates with government on health policy issues not all of which have a monetary gain for doctors, in fact some have a monetary loss on some IMO members ie smoking ban, less cardiac surgery -poorer cardiac surgeons, Increased price on alcohol, less drinking, less need for liver specialists

The IMO makes submission to government every year on issues such as these and

• child health
• childhood vaccinations
• food safety
• nursing home standards
• overseas medical aid
• conditions in prison
• health needs of population
• acute hospitl beds
• mendical card income limits
• cancer screening

HAve a look back at the media coverage around the time of IMO agm and you will range of issue discussed which do not have direct financial benefit for doctors but which they feel are important social issues

A union that does not act on its members interests though is asking for trouble

I have met him a few times, man with a conscience and wanted to do something about it, he would earn far more money, have an easier life and not be a media figure if he stuck with medicine

You may nt give a toss for his opinion but having watched oireachats report MAry Harney can look decidedly shaky when he asks questions as he has a probitive knowledge of what teh answer should be

I think he is doing a great job. Did not really think the same of the other medics in the Dail and they have never had the same degree of action that he has done in the last 2 years

drzhivago

ZYX wrote: »

I certainly feel it was wrong and I have never met a GP who felt the over 70s deal was right for general practice. It meant huge sums of money were spent in wealthy areas and not in more deprived areas.

I agree with you, argued against it at the time, had elderly representative groups criticise me for being anti elderly, was on radio with one trying to explain that raising means would have the same effect for all the poor elderly but would leave very rich elderly out who could still afford health insurance and the out of pocket expenses

at time government decided to do it alone, IMO had to negotiate on that issue alone, what were they to do say OK we will do it , thanks lads dont worry about it

It wa s fundamental change in GMS system which has now been reversed but the damage was done

cynical votes which they will lose shortly, extending the income limits would hve covered a lot more people particularly now when some are going back to 3-day working weeks which I thought we left behind us in the 1980's

RobFowl

ZYX wrote: »

It is not the HSE that needs to change. Individual doctors should get in the habit of prescribing generically. Even if there is no generic available. If doctors took responsibility themselves for the drugs prescribed millions could be saved every year.

Stangely enough I don't think any of the GP software packages actually let you !
Socrates certainly doesn't and health one didn't (at least 4 years ago when I last used it)

drzhivago

ZYX wrote: »

It is not the HSE that needs to change. Individual doctors should get in the habit of prescribing generically. Even if there is no generic available. If doctors took responsibility themselves for the drugs prescribed millions could be saved every year. Simply ask a few questions
1 Does this person really need medication?
2 Will patient take it if prescribed?
3 What is the cheapest class of drug that would benefit this patient?
4 Is there a generic available?

I agree but there needs to be s tep backwards from here

In hospitals some pharmacies control the hospital formulary

Some companies provide their drug free to the hospital, hence name 1 on the formulary, gets prescribed in hospital to save costs and then when patient discharged on X drug to GP GP may be reluctant to change because it has apparently been a specialist decision to prescribe these

Interesting article in IMN recently about patients not taking drugs 3-4 times a day and suggesting doctors should be going for once a day meds even if more expensive to ensure compliance

Worked in casualty a long time ago and old ladys came in on multiple meds, septic hypotensive, bradycardic, very confusing

asked family to bring in meds

BAgs and BAgs and BAgs of tablets unused, except the most recent precsription, when she started to feel unwell family started making sure she was actually taking the medication she was supposed to be getting and she got worse, antihypertensives, B Blockers, calcium channel agents the lot

GP had been prescribing meds, patients saying she was taking, gp not noticing desired effect so increasing dose and then when she actually gets the meds bottoms out

This is not unique, why people take the scripts and get the meds should be examined if they have no intention of taking

ZYX

drzhivago wrote: »

I agree with you, argued against it at the time, had elderly representative groups criticise me for being anti elderly, was on radio with one trying to explain that raising means would have the same effect for all the poor elderly but would leave very rich elderly out who could still afford health insurance and the out of pocket expenses

at time government decided to do it alone, IMO had to negotiate on that issue alone, what were they to do say OK we will do it , thanks lads dont worry about it

It wa s fundamental change in GMS system which has now been reversed but the damage was done

cynical votes which they will lose shortly, extending the income limits would hve covered a lot more people particularly now when some are going back to 3-day working weeks which I thought we left behind us in the 1980's

Giving medical cards to all over 70s was the right decision. The problem was the very large amounts of money given to GPs if patient was private at time they turned 70. All over 70s should have medical card and payment to GP should be the same irrespective of whether patient was previously private. I assume the IMO would not stand for this.

drzhivago

ZYX wrote: »

Giving medical cards to all over 70s was the right decision. The problem was the very large amounts of money given to GPs if patient was private at time they turned 70. All over 70s should have medical card and payment to GP should be the same irrespective of whether patient was previously private. I assume the IMO would not stand for this.

I disagree entirely with the thrust

THe scheme was and is set up as a means based system of providing health care for those that otherwise could not afford it

It is not designed on health need ie very sick nor was it designed on age grounds.

IMO raised same objection when suggestion was to give medical cards to all children under 5

As scheme stands the agreement allows for up to 40% of population to be covered under means based system without need for any negotiations

Increase the means and the vast majority of elderly, even those on pensions would qualify, as would a significant number of younger people with young families

There would have been no need to negotiate with IMO as they had asked for income limits to be increased

Most elderly would have been covered except retired bankers/consultants/judges etc ie those who could afford their healthcare

THe GMS would then have remained intact as a scheme set out to provide for those with most need and not changed on a political whim to catch a group of voters

When government decided to change structure of scheme they had to negotiate with IMO

Had they changed limits they woudlnt have had to pay more, they would have saved money but you would have had a rich elderly lobby who felt left out, interestingly that group would have strong links to government...hmmmmm

ZYX

drzhivago wrote: »

I disagree entirely with the thrust

THe scheme was and is set up as a means based system of providing health care for those that otherwise could not afford it

It is not designed on health need ie very sick nor was it designed on age grounds.

IMO raised same objection when suggestion was to give medical cards to all children under 5

Yes but why? What is wrong with universal health care, and, if that is not available then universal for all under 5s and over 70s. The UK has a universal health care system which is far better than Irelands and is provided at 3/4 of the cost per patient despite having an older population.

drzhivago wrote: »

As scheme stands the agreement allows for up to 40% of population to be covered under means based system without need for any negotiations

Increase the means and the vast majority of elderly, even those on pensions would qualify, as would a significant number of younger people with young families

There would have been no need to negotiate with IMO as they had asked for income limits to be increased

THe GMS would then have remained intact as a scheme set out to provide for those with most need and not changed on a political whim to catch a group of voters

When government decided to change structure of scheme they had to negotiate with IMO

that is a ridiculous argument. The IMO did not have to "negotiate". They could have simply said yes that's fine. The idea that the GMS is such a fantastic system at present and it is the IMO that is defending it simply does not wash. It was pure greed on behalf of doctors.

drzhivago wrote: »

Most elderly would have been covered except retired bankers/consultants/judges etc ie those who could afford their healthcare
Had they changed limits they woudlnt have had to pay more, they would have saved money but you would have had a rich elderly lobby who felt left out, interestingly that group would have strong links to government...hmmmmm

The current system simply adds another layer of beurocracy for very little gain. The extra overall cost of providing medical card to all over 70s at the same rate would have cost very little

drzhivago

ZYX wrote: »

Yes but why? What is wrong with universal health care, and, if that is not available then universal for all under 5s and over 70s. The UK has a universal health care system which is far better than Irelands and is provided at 3/4 of the cost per patient despite having an older population.

Now you are introducing a new concept
Personally I dont believe there is anything wrong with Universal health care but that is not what government policy is nor was that what the over 70's was about.

Universal means all not just some groups based on age some groups based on sickness

Regarding UK system how often does a patient get to see GP on same day of request.

UK system is far better for the practice support that surrounds general practice but not for its access to general practice which i would say is arguably a quantum better in Ireland for those with medical cards.

ZYX wrote: »

that is a ridiculous argument. The IMO did not have to "negotiate". They could have simply said yes that's fine. The idea that the GMS is such a fantastic system at present and it is the IMO that is defending it simply does not wash. It was pure greed on behalf of doctors.

Firstly I would say that most GPS would be glad you are negotiating their workload if the attitude is fine I will just take it all on for no extra cost. I take it you are not a GP then faced with this work.

Take a young person with no medical card who is relatively well, average visitation rate is very low

TAke same person who now has medical card, visitation rate is above 3 visits per year, WHY

Who pays for the work involved. The capitation fee for a young person does not cover that

Take the elderly person without card who has health needs, there is an income stream for services provided

Give that person a card, visitation rate may not change much as they have a pattern of health need but income to practice has gone down significantly, they have a card so practice now gets €140, does that make up for income loss

as well as being a caring profession there is also the business end of the practice to look after as well

I dont see where the IMO are defending the GMS per se but defending the agreement they have with the government about providing healthcare. If the government want a completely different system such as Universal health care then set it up and cost it out appropriately

ZYX wrote: »

The current system simply adds another layer of beurocracy for very little gain. The extra overall cost of providing medical card to all over 70s at the same rate would have cost very little

The current system is the current system. I dont like it but that is what we have

Change it by all means, that is a different thread and different economic and social agenda

I would welcome it by the way as I think it would be fairer to have universal health care

As you say above if I understand correctly the overall cost of adding over70s would have cost very little- who would it have cost very little the Government or the GPS

ZYX

drzhivago wrote: »

Regarding UK system how often does a patient get to see GP on same day of request.

The vast majority (90%) are seen within 48 hours. However this is because there are less GPs per head of population than in Ireland

drzhivago wrote: »

Firstly I would say that most GPS would be glad you are negotiating their workload if the attitude is fine I will just take it all on for no extra cost. I take it you are not a GP then faced with this work.

I am a GP

drzhivago wrote: »

Take a young person with no medical card who is relatively well, average visitation rate is very low

TAke same person who now has medical card, visitation rate is above 3 visits per year, WHY

Based on what? In UK average person visits their GP 4 times a year. I do not have figures for Ireland but I would be very surprised if it was any different. At present people with medical cards attend GPs more often but that is because they are in the group with most health needs. There is no evidence that extending medical card coverage will increase doctor visits.

drzhivago wrote: »

Take the elderly person without card who has health needs, there is an income stream for services provided

Give that person a card, visitation rate may not change much as they have a pattern of health need but income to practice has gone down significantly, they have a card so practice now gets €140, does that make up for income loss

Practice gets €140 plus money towards running practice, nurses pay, secretaries pay etc. Average practice should not be any worse off.

RobFowl

ZYX wrote: »

Based on what? In UK average person visits their GP 4 times a year. I do not have figures for Ireland but I would be very surprised if it was any different. At present people with medical cards attend GPs more often but that is because they are in the group with most health needs. There is no evidence that extending medical card coverage will increase doctor visits. .

The average "private " patient visits their GP 2.7 times a year, the average GMS/medical card patient visits 6 times a year. I have the reference for that but not to hand.
Also during the over 70's negotiations the IMO provided data which the DOH did not dispute which suggested the visitation rate for over 70's was about 10 visitis per year.

ZYX

RobFowl wrote: »

The average "private " patient visits their GP 2.7 times a year, the average GMS/medical card patient visits 6 times a year. I have the reference for that but not to hand.
Also during the over 70's negotiations the IMO provided data which the DOH did not dispute which suggested the visitation rate for over 70's was about 10 visitis per year.

Thanks. So pretty much identical rates for UK and Ireland on average.

RobFowl

ZYX wrote: »

Thanks. So pretty much identical rates for UK and Ireland on average.

Fairly similar alright, the fact that GMS patients visit twice as often is not fully understood, some is due to health factors as they tend to have more chronic illness but there is also evidence that a fee stops some people attending GP's (recent survey on irishhealth.com)

Blazer

To be honest I think every OAP should have free medical regardless of whether they can afford the money or not.
If they want better care and can afford well let them pay for it otherwise they get the standard.
These people have been paying taxes for the majority of their live and get fcukall in return.
I know when I retire that I'd be majorly pissed off if I got screwed like that.
I estimate that I pay around €25000 a year in tax between PAYE/PRSI/DIRT/Bank charges/VAT/Excise duty/VRT etc.
So €25,000x let's say 35 years by the time I retire is approx €875,000.
That's a lot of tax paid..so when I need an op when I'm 70 years of age I better not get any grief over it costing €50,000 or something when I've paid this amount. :mad:

drzhivago

RobFowl wrote: »

The average "private " patient visits their GP 2.7 times a year, the average GMS/medical card patient visits 6 times a year. I have the reference for that but not to hand.
Also during the over 70's negotiations the IMO provided data which the DOH did not dispute which suggested the visitation rate for over 70's was about 10 visitis per year.

reference was GMS paymenst Board from 2003 and 2004 I believe

I took out the figures for <20 and <30 at the time for a project I was doing in public health Masters

The over 70s visitation is significant

The point I am trying to make to ZYX is that the IMO negotiates on behalf of work done, more work usually means more pay not less.

Second the scheme is not designed on age but on means, change the scheme I would be in favour of that but change it in toto not just in part there are many other parts of it that dont work correctly

Father in law is GP and I have had to help him go through a number of things related to paymenst over the years

• cards cancelled because patient didt send back a form by a certain date but they have in their possession a card that says validuntil 2010--outcome father in law not paid
• people applying for card get letter saying it is under review, GP doesnt charge-card eventually comes but valid from date in future not for services given-

The only time I have seen him get paid money when there could be a question over whether he should have is when a patient dies, although saying that healthboard personnel very quick to go through death certs etc and his work doesnt end with death. he has said he has up to 4 family visits related to death of a person, not for treatment for themselves but to sort out issues related to the death ie life insurance for deceased or for family members/implications for family member of the condition person died from, pension issues.

Not sure myself why GP doping all that but that is what he says happens in practice, he is seen as a government type official because of his role in GMS and thus this work extends from that!!!!

drzhivago

Mathew Reilly wrote: »

To be honest I think every OAP should have free medical regardless of whether they can afford the money or not.
If they want better care and can afford well let them pay for it otherwise they get the standard.
These people have been paying taxes for the majority of their live and get fcukall in return.
I know when I retire that I'd be majorly pissed off if I got screwed like that.
I estimate that I pay around €25000 a year in tax between PAYE/PRSI/DIRT/Bank charges/VAT/Excise duty/VRT etc.
So €25,000x let's say 35 years by the time I retire is approx €875,000.
That's a lot of tax paid..so when I need an op when I'm 70 years of age I better not get any grief over it costing €50,000 or something when I've paid this amount. :mad:

Sorry Mattew you are missing the point a bit
This is about MEdical cards ie free GP care and not hospital care

You would not be asked to pay for your operation unless you chose to be a private patient. There is a bed stay charge which has a limit of 10 days in one year I think but that is it

I take your point about what ypu pay in taxes but that is to pay for everything required to run the country

If you are paying 25,000 then you are earning around 60-75 depending on bands

If you get a maximum pension, of 25,000 you would qualify for a GPP visit card biut not free medications as far as I understand the current system

drzhivago

ZYX wrote: »

Thanks. So pretty much identical rates for UK and Ireland on average.

Not sure how you say that ZYX as my understanding is that there arent "private" GP patients in UK

are you saying GMS visitation rate similar to NHS visitation rates

If so, presume you worked in NHS what practice supports were available there to you that an Irish GP has to pay for themselves from practice income

drzhivago

ZYX wrote: »

The vast majority (90%) are seen within 48 hours. However this is because there are less GPs per head of population than in Ireland

So not good access then

ZYX wrote: »

Based on what? In UK average person visits their GP 4 times a year. I do not have figures for Ireland but I would be very surprised if it was any different. At present people with medical cards attend GPs more often but that is because they are in the group with most health needs. There is no evidence that extending medical card coverage will increase doctor visits.

GMS payments board data
You are confusing two different topics here
A system based on giving medical cards for economic reasons and als the health needs of those on low incomes

There is quite a bit of evidence that persons on low income without medical cards ignore personal health issues but then present when they have a medical card, in particular mother sacrifice their personal health to ensure children get to GP

ZYX wrote: »

Practice gets €140 plus money towards running practice, nurses pay, secretaries pay etc. Average practice should not be any worse off.

Very simplistic here, as homer once said 80% of statistics are made up on the spot

€140 doesnt offset 10 private visits

Practice supports for secretary doesn't cover cost of secretary, that comes from practice income, if practice income goes down then money has to be found from somewhere

If practice already has maximum secretary and nurse support they cant gain any additional but practice will be losing revenue so there is a cost

Doctors are pretty poor in general about organising the financial aspects of their practice and charging what is a realistic figure for consultation based on ALL te costs of running the practice

ZYX

drzhivago wrote: »

Not sure how you say that ZYX as my understanding is that there arent "private" GP patients in UK

are you saying GMS visitation rate similar to NHS visitation rates

If so, presume you worked in NHS what practice supports were available there to you that an Irish GP has to pay for themselves from practice income

Well of course there are private patients in UK but that was not what I was talking about.

According to RobFowl and you, private patients in Ireland attend GP 2.7 times a year. GMS patients attend 6 times a year. This means the average Irish patient (average of Public & Private) attends 4 times a year. This is the same figure as in UK where everyone has medical card. In UK those in lower SE groups attend more often just like in Ireland. But the average in the two countries is the same.

ZYX

drzhivago wrote: »

So not good access then

The access is not quite as good as Ireland but that is due to the much lower numbers of Gp employed in UK compared to Ireland.

drzhivago wrote: »

Very simplistic here, as homer once said 80% of statistics are made up on the spot

€140 doesnt offset 10 private visits

Practice supports for secretary doesn't cover cost of secretary, that comes from practice income, if practice income goes down then money has to be found from somewhere

If practice already has maximum secretary and nurse support they cant gain any additional but practice will be losing revenue so there is a cost

Doctors are pretty poor in general about organising the financial aspects of their practice and charging what is a realistic figure for consultation based on ALL te costs of running the practice

But your point is that €140 is ok (at least at no point have you said it is not) if patient is from a lower SE group and more likely to have high health care needs. But, if patient was private, by definition is wealthier, should have lower health care needs, then the GP should be paid more. That is the point I don't get

RobFowl

ZYX wrote: »

The access is not quite as good as Ireland but that is due to the much lower numbers of Gp employed in UK compared to Ireland.

The most recent figures I can get showing a direct comparison (2004) show that there were 61.97 gp's per 100000 population in Ireland and 67.29 in the UK. Interestingly In France there were 164 GP's per 100000 that year. And in the Netherlands (generally considered to have one of the best health care systems in Europe there were 52 GP's per 1000000.
Would be interested to see where you data that there are more GP's in ireland came from ?
http://data.euro.who.int/hfadb/tables/tableA.php?w=1152&h=864

NHS data also shows the number of GP's in the UK increased by about 10% from 2004 -2008
http://www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhs-staff-1998--2008-general-practice

ZYX

RobFowl wrote: »

The most recent figures I can get showing a direct comparison (2004) show that there were 61.97 gp's per 100000 population in Ireland and 67.29 in the UK. Interestingly In France there were 164 GP's per 100000 that year. And in the Netherlands (generally considered to have one of the best health care systems in Europe there were 52 GP's per 1000000.
Would be interested to see where you data that there are more GP's in ireland came from ?
http://data.euro.who.int/hfadb/tables/tableA.php?w=1152&h=864

NHS data also shows the number of GP's in the UK increased by about 10% from 2004 -2008
http://www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhs-staff-1998--2008-general-practice

England has 27,347 GPs for a population of 51 million. (based on your figures from NHS)

Ireland has about 3000 GPs (according to ICGP although real figure is probably higher) for a population of 4.2 million

http://www.irishhealth.com/article.html?id=12827
"ICGP Chairman Dr Mark Walsh said the HSE has indicated that there will be no funding provided this year for a planned expansion in the number of GP trainee places, despite the HSE previously promising to fund this expansion.
Dr Walsh has warned that even with the planned increase in trainee numbers to 150, there was still likely to be a major shortfall in the number of GPs over the next 10 years, and this shortfall is now set to worsen as a result of the funding problem.
He warned that Ireland could have a shortfall of 551 GPs by 2015. There are approximately 3,000 GPs in practice in Ireland at the moment."


So Ireland has much more GPs than England and I think it is fair to assume the rest of UK also.

RobFowl

ZYX wrote: »

England has 27,347 GPs for a population of 51 million. (based on your figures from NHS)

Ireland has about 3000 GPs (according to ICGP although real figure is probably higher) for a population of 4.2 million

http://www.irishhealth.com/article.html?id=12827
"ICGP Chairman Dr Mark Walsh said the HSE has indicated that there will be no funding provided this year for a planned expansion in the number of GP trainee places, despite the HSE previously promising to fund this expansion.
Dr Walsh has warned that even with the planned increase in trainee numbers to 150, there was still likely to be a major shortfall in the number of GPs over the next 10 years, and this shortfall is now set to worsen as a result of the funding problem.
He warned that Ireland could have a shortfall of 551 GPs by 2015. There are approximately 3,000 GPs in practice in Ireland at the moment."


So Ireland has much more GPs than England and I think it is fair to assume the rest of UK also.

There were 27327 GP's in England in 2001 but 34010 in 2008 according to the NHS figures.
I wouldn't be too sure the accuracy of a quote from a GP approximating the number of GP's in a medical newspaper would be superior to the WHO figures.
Truth be know I was involved in a North Dublin project and with all the HSE/ICGP/Medical council information we were unable to get an accurate figure of how many GP's are actually in practice.
Also the figure you quote includes locum and sessional GP's the NHS figure excludes them. When you check the NHS figures once retainers (not locums) are included then the figure increases to 37000. This shows a higher level of GP's in England than here and as you point out presumably the rest of the UK as well.

Sorry to be pedantic but I feels the figures show at best there are almost similar amounts of GP's pro rata in the UK and Ireland and it has to be accepted that the level of backup in the NHS in terms of support staff, nurses, physio, podiatry and other PAMS is vastly more developed.

Personally I found the Dutch figures far more interesting as that is seen to be a better model than the UK, also the French figure explains the high patient satisfaction rates they have (and the reason they are can't afford to keep up that level of service!)

ZYX

RobFowl wrote: »

There were 27327 GP's in England in 2001 but 34010 in 2008 according to the NHS figures.
I wouldn't be too sure the accuracy of a quote from a GP approximating the number of GP's in a medical newspaper would be superior to the WHO figures.
Truth be know I was involved in a North Dublin project and with all the HSE/ICGP/Medical council information we were unable to get an accurate figure of how many GP's are actually in practice.
Also the figure you quote includes locum and sessional GP's the NHS figure excludes them. When you check the NHS figures once retainers (not locums) are included then the figure increases to 37000. This shows a higher level of GP's in England than here and as you point out presumably the rest of the UK as well.

Sorry. Yes I misquoted your figures. It is 34,000 including part time GPs (it has gone up a lot since I worked there) and 31,000 whole time equivalents. The figure of 37,000 you have seems to be including registrars. Retainers, which are basically sessional GPs, total 507.

I spoke to a GP a couple of years ago who was working with ICGP to determine man power needs. He, like you was unable to say how many GPs there are in Ireland, but his estimate was 3400. (hence where I said above figure was probably higher than 3000 but that was only one I could find in print).

On a seperate point I find it strange that IMO and ICGP can regularly say we do not have enough GPs yet cannot say how many we actually have or how many we actually need.

RobFowl

ZYX wrote: »

On a seperate point I find it strange that IMO and ICGP can regularly say we do not have enough GPs yet cannot say how many we actually have or how many we actually need.

Totaly agree.
Also when you see the Dutch have 52 per 100000 and we have some where in the high 60's per 100000 yet they seem to run a very good service it makes it even more confusing.
Personally I think there are enough GP's already but the set up costs and lack of transparent access to the GMS are the real barriers to proper service provision.

ergo

RobFowl wrote: »

Stangely enough I don't think any of the GP software packages actually let you !
Socrates certainly doesn't and health one didn't (at least 4 years ago when I last used it)

In the NHS there is "scriptswitch" and, when I, for example, try to prescribe Escitaloprim a box will pop-up warning me that I should really be prescribing citaloprim (or words to that effect) and of the much higher cost of Escitaloprim - I can still go and prescribe it though - but the practice will take a hit financially if we go over our drug budget for the year

also there are frequent audits and figures published of which practises in which areas are appopriate prescribers or , for example, high antibiotic prescribers - very useful info - how far away from that are we in IRL...?

Scriptswitch will also usually say things like "warning - generic available of same preparation for a lower price etc etc"

and very occasionally it will suggest using the branded rather than the generic because that is cheaper - that is rare now, but there is one - think it's an anti-fungal cream or something - where the brand is cheaper than the generic

regarding GP ratios etc to further quote the ICGP statementhttp://www.icgp.ie/go/about/press_releases/551D621E-19B9-E185-832727A1824E9F44.html

"

A report produced by the skills and labour market research unit within FAS in 2005 refers to OECD figures that indicate the ratio of GPs employed per thousand of the population in Ireland is the second lowest in the EU. The EU average is approximately one GP per thousand of the population. The Irish ratio is less than half the EU average at 0.47 per thousand."

RobFowl

ergo wrote: »

In the NHS there is "scriptswitch" and, when I, for example, try to prescribe Escitaloprim a box will pop-up warning me that I should really be prescribing citaloprim (or words to that effect) and of the much higher cost of Escitaloprim - I can still go and prescribe it though - but the practice will take a hit financially if we go over our drug budget for the year

also there are frequent audits and figures published of which practises in which areas are appopriate prescribers or , for example, high antibiotic prescribers - very useful info - how far away from that are we in IRL...?

There are only 3 (AFAIK) GPIT approved software systems in the ROI. I've used 2 and our present one won't allow you to prescribe generically although it will show the cheapest branded generic and let you prescribe that !
A mate of mine who's a GP in Wales got a slap on the wrist for having the cheek to prescibe lipitor !

ergo wrote: »

regarding GP ratios etc to further quote the ICGP statementhttp://www.icgp.ie/go/about/press_releases/551D621E-19B9-E185-832727A1824E9F44.html

"

That is very interesting. The same people quoted a very diferent figure in the link ZYX quoted

drzhivago

ZYX wrote: »

Well of course there are private patients in UK but that was not what I was talking about.

According to RobFowl and you, private patients in Ireland attend GP 2.7 times a year. GMS patients attend 6 times a year. This means the average Irish patient (average of Public & Private) attends 4 times a year. This is the same figure as in UK where everyone has medical card. In UK those in lower SE groups attend more often just like in Ireland. But the average in the two countries is the same.

No its not

Private patients in Ireland=73% of populations
GMS patients 27% and falling up until this year

so the average will be on the lower side

drzhivago

ZYX wrote: »

The access is not quite as good as Ireland but that is due to the much lower numbers of Gp employed in UK compared to Ireland.

Sorry for delay but say fowl has answered some of this but employed GP numbers in UK significantly higher than here

Numbers of wholetime equivalents in UK significantly higher than here

Numbers of GPS here guesstimated from those receiving money from GMS payments board, those registered with ICGP


Some included incorrectly in figures include

• gp trainees
• locum gps who may work significantly less than full time
• academic staff in medical schools who locum as gp
• NCHDS who provide services to co-ops and dublin on call services

retired GPS not practising but still on ICGP active register

ZYX wrote: »

But your point is that €140 is ok (at least at no point have you said it is not) if patient is from a lower SE group and more likely to have high health care needs. But, if patient was private, by definition is wealthier, should have lower health care needs, then the GP should be paid more. That is the point I don't get

Misquoting me here now ZYX

I didnt say €140 was OK what I said was that if government had extended income limits then more elderly would have received cards and the docs would have been paid that figure without any need for negotiations

From docs perspective they would have had to take the rough with smooth as no mechanism to renegotiate

when government sought to change the rules for the scheme that opened door to renegotiations and hence the figures that arose as that was all they could negotiate on

Now if you have a moral objection you could give the money back,

Health status of those in 70's is a mire of multiple theories,
survival theory-if they are that old they are survivors nothing wrong with them-
determinist theory as they are old things must be going wrong thus higher health needs-
socialist theory - low incomes=low health hence higher needs
economic theory- higher wealth== diseases of excess - higher health needs

Pick your theory and run with it

What I can say from working on father in laws stats is that 140 wouldnt come close to his costs for practice.If his practice was entirely made up of elderly medical card patients he would lose money hand over fist