Hawkins House Presentation on Irish Primary care Statistics Thursday 24th January 2013 @ 3 pm by GP Dr William Behan to senior HSE and Department of Health staff based on Dr William Behans 2013 FEMPI (Financial Emergency Measures in the Public Interest Act) submission

1. Dr. WILLIAM BEHAN
M.B., B.Ch., B.A.O., L.R.C.P. & S.I., D.C.H., M.S.O.M., M.I.C.G.P.
Phone: Surgery 460 2263 115 Cromwellsfort Road,
If no reply 453 9333 Walkinstown,
Dublin 12
Hawkins House Presentation on Irish Primary care Statistics
Thursday 24th
January 2013 @ 3 pm
To discuss the many conflicts with the tenets in the 2011 European Statistics Code of
Practice Report and the International Standard on Auditing (UK and Ireland) 700
(Revised) when reporting Irish health data.
Mark Pearsons presentation at the October 2011 ESRI Budget Perspectives
conference: “The Performance of the Irish health System in an International
Context” OECD report on GP income, claiming that there is a rate of 0.5 general
practitioners per 1,000 population in Ireland (true figure would be closer to 3,000 GPs in
a population of 4.58 million – PCRS would probably have the best data), or the annual
number of consultations per GP which underestimates (using CSO data as well as this
error) the true rate by over 80% and underestimates workload per GP. OECD Health
Data uses the same figures. The 2011 OECD Health at a Glance report clearly
identifies the reliability issue with CSO data, as “estimates from administrative sources
tend to be higher than those from surveys because of problems with recall and non-
response rates
The Primary Care Reimbursement Service (PCRS) calculation of GMS payments to
GPs per person has been reported at 12 per cent higher than the true figure over the 2007-
2009 period. This has since been corrected to reflect pure GMS income but has not
included the DVCs in the denominator. This exaggerated statistic was then used by
various reports including Competition in Professional Services General Medical
Practitioners Report 2009a and the ESRI Report – Resource Allocation, Financing
and Sustainability in Health Care: Evidence for the Expert Group on Resource
Allocation and Financing in the Health Sector. CSO data, along with erroneous
PCRS calculations, greatly alter the calculations in ESRI reports to cause an over-
estimation of GMS payments per consultation by up to 47 per cent. The recent Irish
Patients Association report over-estimates the cost of providing universal health
insurance (UHI) by 42 per cent.

2. The 2011 OECD Health Data Report overestimates the GMS GP State income after
expenses by possibly 50%. - I have used the Regulatory Impact Analysis Guidelines —
Basic Salary + Employers 10.75 per cent PRSI + 40 per cent Basic Salary in respect of
‘overheads’ to calculate a more realistic cost for the nurses and administrative staff
expenses.
My final calculation for the total income in 2008 for the 2,098 GMS GPs after true total
expenses was €229,469,490, or €109,375 per GMS GP, which is considerably less than
the figure of €166,229 forwarded by the DoH to the OECD.
Otherwise, 50-60% total income can be assumed as overheads (Private income is
dropping precipitously for some GPs.)
Central Statistics Office (CSO) Quarter 3 2007, Quarterly National Household
Survey report under-reflects patient attendances, particularly in the over-65-year-old age
group when compared to the equivalent UK General Household Survey, and audits of
Irish local and UK national general practice administrative records.
Historically the annual autumn media release by the HSE National Press and Media
Relations Office has under reflected the payments for vaccines administered to the over
65 year old medical card population by at least 2% each of the last 4 years, while in 2009
the disparity was greatest when it quoted a figure of 58.2% and the final official uptake
rate was 70.1%. Even that figure does not include vaccines successfully administered
and documented locally but not paid for.
2011/2012 2010/2011 2009/2010 2008/2009 2007/2008
63.8%; 53.8%; 70.1%; 61.7%;
MY DATA taken from Epi-Insight / OECD Health report
56.5%; 60.1%; 51.6%; 58.2%; 57.2%;
HSE National Press and Media Relations Office DATA
Audit of my own practice records shows that we immunised 733 people in 2011-2012
against the influenza, however HSE monthly pink sheet statement records that we
claimed 709 and were paid for 707. Reconciliation with our hard copy STCs shows that
we claimed ______.
14/12/2012 Fred and I had 742 GMS 65y.o.+; 14/12/2011 747 GMS 65 y.o.+

3. The Irish Independent 2013 New Year’s Day front page contained a statement from a
HSE source claiming that the average GP fee per medical card holder is €280.
The truth is GP annual fees for medical card patients depending on their age vary from
€44.68 to a maximum of €133.87 for patients under the age of 70. The annual GP fee for
patients over 70 is €280.31, but this population comprises less than 18% of the current
number of medical cards. .
I am expecting the final calculation to be about €244.54 in the much Primary Care
Reimbursement Service Statistical Analysis of Claims and Payments 2011 Report
(e445,000,000/1,819,720), and about €225 – 230 per patient for 2012 based on current
trends.
The April 2012 PWC Medical Card Report contained the implication that Irish GPs have
been overpaid by €65 to 210 million. November 14th
2012 (the day before the self-
employed revenue payment deadline), the PCRS finalized its claim for the grand total of
€350,000 from General Practice, however it has still to process a significant
underpayment to us based on 16 y.o. patients who lost their medical cards, and other
issues. This was meant to be updated by August 2012, then September 2012.
Conversation with Toland PWC, Health – Another company was commissioned for the
follow-up.
(Irish Times, November 29, 2012) on the European Observatory on Health Systems
and Policies report.
The report commented that it costs around €51 per GP visit in Ireland, compared to
around €22 in France. The clear implication is that the French spend a lot less on
attending their GP than the Irish.
The previous report on the Irish health system by the European Observatory on Health
Systems and Policies, ‘Health Systems in Transition, Vol. 11, No. 4, 2009, Ireland,
Health System Review’ a “typical” consultation is costed at “€60-€80”. Is that report the
reason that the IMF allegedly complains so often about Irish GP fees?
Also, there appears to be an increased element of supplier-induced demand, which is
indicated by the 6.7 consultations per patient per annum and causes an indirect cost on
patients attending their GP, when Irish consultation rates based on audit of GP records
show a consultation rate of about 4.6 per annum (private patients, 2.6 visits per annum).
It should also be noted that OECD data indicates that a very low level of unmet need for
medical consultations due to cost exists in Ireland, and that general practice and public

4. The March 2010 National Review of Out of Hours Services by the HSE, which
compared HSE costs to the Northern Ireland equivalent service, failed to take into
account the following:
o The five-times greater land mass covered;
o The 4.5-times more centres used;
o Double the over-70s population covered;
o The greater medical need of the under-70s with medical cards;
o The different payment structure for general practice in the UK;
o Differences in the rate of exchange and purchasing power parity; and
o All Irish State citizens are allowed access to the service.
_________________________

5. (a) The Primary Care Reimbursement Service (PCRS) Annual Accounts.
The PCRS Annual Accounts 2009 calculates the doctors’ payments per GMS patient at
€337.94 when the applying of correct methodology to the same relevant data derives a
sum of €295.99.
The same error has been made in previous annual reports because the PCRS calculation is
based on the total of (GMS, including superannuation and benefits paid to retired DMOs
+ Mother and Child Scheme + Primary Childhood Immunisation Scheme + Methadone
Scheme income)/(Total number of GMS patients — GP doctor visit patients).
My calculation is based on GMS (including superannuation and benefits paid to retired
DMOs) income/total number of GMS patients.
(b) OECD Health Data Reports.
Irish self-employed GP remuneration statistics in 2011 OECD Health Data Reports based
on information supplied to it by the Department of Health (DoH) are meant to reflect
personal pre-tax income after all practice-related expenses for GMS GPs working full
time. It calculates the average Irish GP with a GMS list in 2009 receiving an annual GMS
income of €164,598 after expenses. This is based on an average gross income of
€217,715 (not including benefits to retired DMOs) and results in an income-to-expenses
ratio of 76:24.
The DoH calculates both out-of-hours and annual leave income as a personal income and
not an expense. Also, the DoH assessment of costs does not adhere to the Department of
an Taoiseach Regulatory Impact Analysis Guidelines on calculating staff costs, which has
been endorsed by HIQA in its Health Technology Assessment Report.
This calculates Total Staff Cost = A. Mid-point pay range + B. 10.75 per cent Employer
PRSI + C. Imputed pensions cost (typically 25 per cent of A but new levies have reduced
that to 13.5 per cent of A for state employees) + D. Forty per cent of A in respect of
‘overheads’.
To give a good comparison to our data, three lines below the Irish remuneration figures in
the OECD Health Data Report come the UK data. The most recent UK information
comes from 2008 and shows the average contractor GP pre-tax income as Stg£105,300
(€122,876) based on tax returns. This figure comes from the NHS Health and Social Care
Information Centre-produced GP Earnings and Expenses 2008/2009 Report.
Further analysis of that report will show that the average UK contractor GP gross
earnings was £258,600 (€301,711) in 2008/09, with total expenses of Stg£153,300
(€178,900), resulting in an expense-to-earnings ratio of 59.3 per cent. This is in the
context of the average list size of 1,408 patients for all UK GPs, excluding locums.

6. The 2006/07 UK GP Workload Survey found that the average number of sessions worked
per week (normally defined as a half-day) was found to be 7.6 for the contractor GPs and
5.3 for the salaried GPs (average income £57,300 (€66,871)after expenses and before
tax). GP partners held an average of only 87 surgery consultations per week, equivalent
to an average of 11.7 minutes per consultation. In addition, they had an average of 17
telephone consultations.
The NHS funds a UK-salaried GP by three times the amount that the PCRS subsidises
Irish GMS GPs to fund their medical cover costs. The cost of a salaried GP in the UK by
daily rate works out at £503 per full day worked, which translates into about a daily rate
of €636 once rate of exchange and purchasing power parity are taken into account. This
was after total annual expenses of £6,700 (€7,818) for the year 2008/09 were taken into
account. This compares very favourably to the current daily subsidy paid by the PCRS of
€213.23 for locums, which has to also cover a 10.75 per cent employer PRSI payment if
the locum has not formed a company and that sum of €213.23 also has to cover pension
contributions, professional expenses and sick leave.
The UK data breakdown was interesting, with average office and general business
expenses of £13,600 (€15,866); premises £17,400 (€20,292); employee £90,400
(€105,425); car and travel £1,500 (€1,749); interest £3,300 (€3,847); and in the case of
non-dispensing practices, other expenses of £14,600 (€17,025).
Little of this is taken into account by the DoH when providing its own analysis of Irish
GPs’ costs and net pre-tax income.
I have done my own analysis of PCRS GP payments data using OECD/UK guidelines,
where practice costs are truly reflected. I have considered all fees as a true income, with
the exception of the out-of-hours fees, as it has been well established in the 2010 out-of-
hours report that there is considerable personal funding by GPs of deputising agencies,
assistants and locums to provide the medical cover for the service. Many GMS GPs
provide very little of their own out-of-hours (OOH) medical cover. (In the UK, many GPs
opt out of the OOH service.)
I have considered all the allowances as a true expense, with the exception of the rural
practice payments. I have doubled the fees received for locum expenses to reflect a more
significant part payment towards the true expense of employing a locum, which is
generally at least twice the fee paid by the PCRS and since 2009, sometimes there is an
additional employer PRSI contribution of 10.75 per cent to be paid on top of that.
I have used the Regulatory Impact Analysis Guidelines — Basic Salary + Employers
10.75 per cent PRSI + 40 per cent Basic Salary in respect of ‘overheads’ to calculate a
more realistic cost for the nurses and administrative staff expenses.
My final calculation for the total income in 2008 for the 2,098 GMS GPs after true total
expenses was €229,469,490, or €109,375 per GMS GP, which is considerably less than
the figure of €166,229 forwarded by the DoH to the OECD.

7. Issues worth noting are: the UK GP average list size is 1,404 patients and in 2008 the
Irish GMS GP had 685 patients on his/her list. UK over-70 y.o. population comprises
11.5 per cent of the total list, when in Ireland the same age category make up 24.5 per
cent of the list. Irish public patients under the age of 70 would be considered to have
greater medical needs by virtue of them being eligible for a medical card than the average
UK patient under 70. Having a bigger list/practice size confers economies of scale for the
UK practices.
There were also the rate of exchange differentiation and the 2008 OECD 18 per cent
purchasing power parity index difference between the two countries when considering all
these figures.
(d.) CSO Quarterly National Household Survey Health Service Utilisation data in
comparison to the equivalent UK General Household Survey, and also local audits of
Irish general practice administrative records, QRESEARCH and PCRS data.
Another major theme to the IPA report is the extra resources needed as a consequence of
a universal healthcare induced higher workload in primary care. The current workload
estimation is based on extrapolation from the CSO Quarter 3 2007, Quarterly National
Household Survey report looking at Health Status and Health Service Utilisation. The
ESRI also uses this data for estimation of workload and combines it with PCRS data to
assess payments per each patient. In my opinion, the CSO data analysis is very clever in
determining the odds ratio of attending the GP depending on certain characteristics, but
its method of data collection results in an underestimation of attendance rates,
particularly in the elderly population. Also, it ignores contact with any of the 1,700 GP
nurses (IPNA website calculation).
The CSO health consultations data was generated by an interviewer directly asking how
many times the respondent had a surgery, domiciliary or telephone consultation
(excluding telephoning for results) with their GP during the 12-month period prior to
interview. The 2007 survey questioned 21,000 individuals.
It reported that across the state 69 per cent of the population questioned had at least one
consultation with an average of 2.8 consultations per person (5.3 for GMS patients, 2.1
for non-GMS patients) in the previous 12 months. However, it also described how private
patient GP attendance rates increase consistently from the 5- to 14-y.o. age group, but
GMS attendance rates appear to peak in the 45- to 54-y.o. age group at 6.6 GP
consultations per year then consistently decrease with progressive age to 5.3 GP
consultations per over-70 year old patients. Intuitively this does not make sense.
Looking at UK data where the 2004 General Household Survey questioned 20,421
individuals, and the method of data collection was also a face-to-face interview where
one of the questions posed was ‘Did the person talk to their GP for any reason at all,
either in person or by telephone during the previous two weeks (excluding telephoning
for results)?’ A similar question was asked regarding contact with the practice nurse.

8. Recollection of GP contact over the previous two weeks is clearly more reliable than
recollection over the previous year. However, it does effectively reduce the sample pool
of potential GP attendances by 96 per cent. The 2004 UK GHS found that GP contact
consistently increased from the 5- to 15-year-old age group to 75+, with the exception of
females over 75 years old appearing to attend marginally less than the 65- to 74-y.o. age
group, but still more than the 45- to 64- y.o. category. Generally GP consultation rates
were 6.5 per person in the 65-y.o.-plus category, which is a lot more than in the Irish
CSO report.
QRESEARCH is a UK database that has over 30 million person years of observation
from 525 practices spread throughout the UK. Its data is produced by direct analysis of
general practice records. The percentage of QRESEARCH population aged 70 years and
over at 11.84 per cent closely mirrors English census data.
Based on over 20 million consultations annually in more recent years it shows GP-only
consultation rates increasing from 2.87 in 1999 to 3.44 per patient per year in 2009 (CSO
2007 data suggests the equivalent rate in Ireland is 2.8), with a much greater increase in
nurse consultation rates from 0.96 to 1.9 in the same period. It shows a consistent
increase in consultation rate with age.
QRESEARCH data analysis showed a total consultation rates per person years in 2009 of
5.1, reflecting in a rate of 4.3 for the under-70-y.o. population and 10.6 annual
attendances for the 70-plus age group.
A joint audit of two Irish paperless group practices records, my own urban practice in
Dublin 12 and the Red House Practice in Mallow, a mixed town/rural practice, produced
results that were remarkably similar to the recent QRESEARCH data once the increased
deprivation and rate of chronic illness associated with possessing a medical card along
with the increased proportion of GMS population aged over 70 years old compared to the
total UK population over 70 y.o. were taken into account.
This audit had a GMS population of 4,232 (once 122 nursing home patients were
excluded as they were not on the IT system a full year) of which 2,981 were under 70 and
1,251 were over 70 years old. Some 29.6 per cent of the GMS population in this study are
aged over 70 compared to 21.5 per cent of the national GMS population.
It had an estimated private population of 7,140 (unique private patient attendances in the
study year / 0.67 in view of recent CSO data). This calculates as a population that is 37
per cent GMS and very similar to the national ratio.
Between the two practices the clinical staff consists of five full-time GMS principles,
1.75 assistants/locums and four full-time practice nurses.
I used the same criteria as QRESEARCH, 2004 UK General Household Survey and the
CSO for calculating clinic contacts either directly from the appointment list or telephone
calls and domiciliary visits from estimation of the minimal rates. I did not include

9. approximately 25,000 patient annual contacts such as telephone calls looking for results,
repeat prescriptions or other administration.
Our total private patient contact rate including visits to the GP or nurse, telephone
consultations or domiciliary visits was 2.59 per patient per year (including patients who
did not attend in the previous 12 months), and the total GMS contact rate was 7.24 per
patient, resulting in a all patient contact rate of 4.37.
The total consultation rate in the under-70s is 3.63 with the rate in the over 70s being
9.42.
Analysis of our total GMS population shows a total consultation rate of 7.24 which is
marginally more than the QRESEARCH rate of 5.1, but the difference would be
accounted by the percentage of the QRESEARCH over 70 population being 11.84 per
cent when in this two-practice study it is 29.6 per cent and the greater health needs
assumed by virtue of our patients possessing a medical card.
Our rate of all annual consultations was 6.32 for our GMS under-70s, which is a
population with much greater health needs than the UK equivalent age group that had a
contact rate of 4.3 per person in 2009.
The rate of all annual consultations for our GMS over-70s, and the GMS covers 95 per
cent of the Irish population, is 9.44 versus the 10.6 annual attendance rates in the UK
over-70s. The QRESEARCH rate being higher can be possibly explained by them having
a slightly older patient profile in the over-70s then we have in our population.
PCRS data for doctors on fee-per-item of service, which admittedly only covers a few
GMS practices and by nature of the contract encourages patient attendances more than
the capitation contract GPs, shows an overall visiting rate of 8.26 in 2009 and 9.59 in
2008.
This all shows that CSO data greatly underestimates general practice workload.
(e.) Competition in Professional Services General Medical Practitioners Report
2009a and the ESRI Report – Resource Allocation, Financing and Sustainability in
Health Care: Evidence for the Expert Group on Resource Allocation and Financing
in the Health Sector.
This Competition Authority and ESRI reports refer to an average payment of around €65
for every visit made by a public patient in 2008.
This sum is derived from dividing the 2008 Primary Care Reimbursement Service
statistical analysis of claims and payments report sum of doctors GMS fees, allowances,
superannuation and district medical officer related payments (€465,203,669) by the total
number of full medical card patients and not including the DV medical card patients
(1,352,120) to find the cost per patient (€344.05). Then dividing that sum by the CSO

10. estimated 5.3 visits per GMS patient which clearly does not reflect the true workload, and
results in the €64.91 payment per GMS visit.
The true cost per GMS patient per visit in 2008 terms should be calculated at GMS Fees,
Allowances and Superannuation (€457,927,747) divided by the total number of all
medical card patients (1,437,666) to give an annual payment per person of €318.52,
which should then be divided by a number closer to my assessment of 7.24 visits per
GMS patient per year, which gives a more realistic payment per visit of €43.99, which is
32 per cent less than the ESRI assessment. Or to put it the other way around, the ESRI
assessment is 47 per cent more than then my assessment.
(f.) The March 2010 National Review Of Out Of Hours Services by the HSE.
This report compares the €107 million cost of running the national out-of-hours service
and claims it is €90 million more expensive than the Northern Ireland costs of Stg£18.7-
20 million without taking the rate of exchange difference or purchasing power parity into
account.
It implies that the costs to run the service in the South should be similar to the North as
the public populations covered are similar.
It does not take into account that the Southern service covers a landmass that is five times
greater with 86 treatment/call centres versus the 19 centres in the North. There is a much
greater degree of health needs associated with the Southern public patients by virtue of
their eligibility for medical cards and the proportion of public patients that are aged over
70 years is twice the Northern Ireland proportion.
The NHS funds the full costs of providing a day-time primary care service unlike the
GMS.
Since this report there have been great reductions in direct GP funding for out-of-hours
care with minimal reduction in the funding for the HSE associated costs.
This is on a background of a series of cutbacks in gross income despite a great increase in
GMS numbers that are disproportionate compared to the reductions suffered by the rest
of the public service and do not consider the final reductions in net income for us doctors.
Over the same period, HSE management/administrative salary/superannuation costs that
are reflected in the HSE 2010 Annual Accounts increased from €673 million in 2008 to
€699 million in 2010 with a peak in 2009 despite the numbers of staff that have to be
served reducing from 111,026 to 107,972 in the same period. Also HSE accounting
policy is that pensions are accounted for on a pay-as-you-go basis, when GP payments
reflect real and total costs.
(g.) (Irish Times, November 29, 2012) on the European Observatory on Health
Systems and Policies report.

11. The report commented that it costs around €51 per GP visit in Ireland, compared to
around €22 in France. The clear implication is that the French spend a lot less on
attending their GP than the Irish.
The previous report on the Irish health system by the European Observatory on Health
Systems and Policies, ‘Health Systems in Transition, Vol. 11, No. 4, 2009, Ireland,
Health System Review’ a “typical” consultation is costed at “€60-€80”. Is that report the
reason that the IMF allegedly complains so often about Irish GP fees?
Also, there appears to be an increased element of supplier-induced demand, which is
indicated by the 6.7 consultations per patient per annum, when Irish consultation rates
based on audit of GP records show a consultation rate of about 4.6 per annum (private
patients, 2.6 visits per annum).
It should also be noted that OECD data indicates that a very low level of unmet need for
medical consultations due to cost exists in Ireland, and that general practice and public
emergency departments are the most equitable dispensers of healthcare in the country.
This European Observatory report also comments on the large public income Irish GPs
receive from the PCRS, relative to other jurisdictions. It does admit that it only looked at
income before the 2009-2011 FEMPI cuts and the official data excluded practice
expenses, resulting in a clear over-estimation in international comparisons.
It should be noted that currently, about 42 per cent of the national population have a
medical card. They comprise the poorer, older and sicker proportion of the population
and therefore make up about 75 per cent of the workload in general practice.
This year, the GPs in Ireland will receive about 3.5 per cent of the total HSE budget for
tending to that population, when in the UK, GPs, for providing a similar service, will
receive (GP Earnings and Expenses Final report) nearly 7 per cent of the NHS budget for
looking after 100 per cent of the population, and the UK is well known to operate very
frugally. Or to put it as a proportion of GDP: the proportion of the Irish GDP that is
directly spent on GP fees and expenses for the PCRS population (0.3 per cent) is exactly
half the proportion of the UK GDP that is given directly to NHS GPs (0.6 per cent).
The proportion of French GDP that is spent on general practice appears to be between 0.5
per cent and 0.6 per cent of GDP, but that level of funding along with the method of
payment appears to be resulting in a poorly-developed primary care system, with many
GPs working in isolation, even if they are in the same building as their colleagues. Also,
there are very few nurses involved in the French system — all factors which appear to be
causing greatly increased secondary care costs.
Analysis of how the source Irish data is manipulated shows that it attributes less than
€40,000 per PCRS GP for practice expenses. In the UK, where they have a similar
infrastructure and historically slightly less expensive overheads and possibly 35 per cent
more public workload, they are allocated about £162,400 (€200,130) in expenses.

12. Analysis of Irish data often forgets to include up to 700 GPs who may be salaried or
partners of PCRS doctors and looking after PCRS patients, and they also derive an
income indirectly from the PCRS.
Open Letter to Minister Brendan Howlin,
Department of Public Expenditure and Reform.
Dear Minister Howlin,
You have been reported as wishing to reduce the cost base for medical cards (Irish Times
Health Supplement, July, 3, 2012). To support this effort the Primary Care
Reimbursement Service, Department of Health and Children (DoHC), OECD and CSO
have long been consistently over-stating practice profits and GP income per patient while
simultaneously under-estimating GP workload and expenses.
These obvious errors are as a result of either applying flawed methodology to the
interpretation of good data, or applying good methodology to the interpretation of flawed
data.
Your wish should be viewed in the context that the total payment to GPs for the
1,819,720 GMS patients in 2011 was approximately €445 million. Also this 39.7 per cent
of the national population represents the oldest, sickest and most deprived in our country
and probably represents 70-75 per cent of the workload in general practice.
To put the €445 million figure into context, it represents 3.2 per cent of the total HSE
budget for 2011. In fact, GMS GP payments have never been over 3.7 per cent of the
HSE budget (when there was a massive overdue back payment in 2005).
Ireland has historically spent a very low proportion of its GDP on public healthcare. It
spends even less than the UK, which is considered a very frugal system by western
standards. Only in the past few years has the Irish spending rate (9.2 per cent of GDP in
2010) been approaching the OECD average.
GPs in the UK have been receiving between 8 per cent and 11 per cent of the NHS
budget over the past four years to fund their internationally acclaimed public system.
‘Overpaid’ Irish GPs over the past five years have been funded an average of 3.18 per
cent of the relatively lower HSE budget. It was the over-70s medical cards that brought
us from below to just above 3 per cent of the total HSE budget for the first time.
The most recent OECD data on average GP principal income report UK GPs as earning
Stg£105,700 (€133,300) annually. Examination of the source data shows that they work
less than four full days a week and receive an extra £153,300 (€193,310) in expenses.
This is when Irish GPs (after about 1,000 of the lower earning doctors are excluded from
the calculations) are reported, on the basis of previously identified flawed data submitted

13. by the DoHC, as earning an average of €164,598 annually from their GMS contract alone
but are only credited with a cost base of €45,444 to fund a similar overhead structure,
which produces a similar quality public service.
I find it very hard to believe that there is nobody in Irish public service that is not aware
of all the figures I have just mentioned or the logic they represent. Nor do I imagine that
there is a single competent public servant who could find fault with either my numbers,
because the skills needed to extract this data are really quite elementary.
I am concentrating mainly on inputs in this letter, but if you examine in detail current
HSE data on outputs as opposed to what can be done in general practice (not primary care
as the excessive administrative and other inessential burdens of funding, developing and
operating primary care centres using the current HSE model should fail to achieve the
expected clinical savings if current UK and international data is anything to go by), you
will be similarly disappointed.
Dr William Behan,
Walkinstown,
Dublin 12.
Health at a Glance 2011: OECD Indicators BACK
3. Health Workforce
3.2. Medical doctors
Figure 3.2.2 General practitioners, specialists and other doctors as a share of total
doctors, 2009 (or nearest year)