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Ireland — closest to home

In Dublin Dr Gerald Michael finds a familiar set-up, except in key areas of pay and chronic disease management

The first stop on my 12-week tour of Europe interviewing GPs was Ireland.

Similarities between the UK and Ireland are greater than the differences. I visited a Dublin GP, Dr Dermot Shearer, who is part of a new and growing two-partner practice. Like many UK GPs, he has paperless records and practises using international guidelines, especially British sites including NICE, SIGN, and the British Thoracic Society.

Dr Shearer prefers not to have access to the internet from his surgery computer because he is concerned about confidentiality, because ‘evil people’ may hack into patients’ records — perhaps not such a common response in either country.

Different payments

The main differences that I came across appear to be the methods of payment, management of chronic disease and further education.

In Ireland, about 40 per cent of patients are equivalent to our NHS patients in that their care is state-funded, including all over-70s. Only 10 per cent of Dr Shearer’s patients are state-funded. The pay for these is mostly by capitation fees, with some items of service.

Most patients are private. They pay € 45 for the first consultation of an illness and € 30 for follow-ups. They also have to pay for their investigations and medication, up to a limit of € 80 per month.

Consultations for all patients  last 15 minutes. House calls are done but are discouraged because they are not cost-effective for doctor or patient  — who will have to pay extra, probably more than a taxi fare.

Although management of chronic disease is taken seriously — as in the UK — there are no targets and it seems that audit is done spasmodically.

While there are disease registers in good practices, it is difficult to find out what proportion of patients with IHD have their cholesterol, hypertensives their BP and diabetics their HbA1c controlled.

Partly because outpatient treatment is free, all diabetic patients are managed in secondary care, but I am told there are plans to change this.

Referral practice in Ireland appears similar to the UK, and waiting lists for dermatology, hip replacement and neurology are just as bad. Self-referral to private consultants is discouraged.

Direct requests only

There is continuity of care but when private patients change doctors, the new doctor has to contact the old one directly for the records.

Out-of-hours is the GP’s responsibility but is nearly all done by co-ops. However, except in the big cities, GPs are expected to share in the rota.

The practice I visited had no practice nurse but I was told that their use is similar to that in the UK. For example, they follow up BP and do smears. They are paid about € 20 per consultation. Patients are encouraged to have smears but there are no government incentives for this.

Dr Shearer does his continuing medical education through the Irish College of General Practice. There is little in the way of personal development plans, no appraisal and as far as I could discover no plans for reaccreditation. Nor are there any known procedures for reporting poorly performing doctors.

Dr Michael is a retired GP from London

Primary care in Europe

1. How our European neighbours run their GP practices

3. Primary care in Europe: Southern European GPs have little help




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