Introduction of free GP care for U6s led to significant increase in service use

Posted on: 15 May 2018

The introduction of free childhood GP services to all children aged under 6 years has led to a significant increase in their GP visits, according to a new study carried out by researchers at Trinity College Dublin.

In July 2015, all 440,000 children under 6 years of age in Ireland were granted free access to daytime and out-of-hours GP services, regardless of parental income. A new study, conducted by researchers at the Department of Public Health and Primary Care at Trinity’s School of Medicine, has found that the introduction of free GP care has led to a significant increase in visits by children under 6 years to both daytime (29% increase) and out-of-hours services (26% increase).

The study involved an examination of visitation data from eight GP practices in North Dublin and their local out-of-hours service (NorthDoc). Over 300,000 face-to-face consultations occurring over one year before to one year after the introduction of free care were analysed. The research has recently been published in the journal ‘Annals of Family Medicine’.

The study also found that while use of daytime and out-of-hours services increased across all age categories over the study period, the under 6s were responsible for a disproportionate amount of the increased workload. 45% of additional visits to daytime GP services in the year after the introduction of free care were made by children under 6. This cohort was responsible for 73% of the increase in visits to out-of-hours services.

“It is no surprise really that GP services are used more often when free,”  said  lead study author Dr Michael O’Callaghan, general practitioner and researcher at the School of Medicine’s Department of Public Health & Primary Care, Trinity College Dublin.

“This study shows conclusively that large numbers of additional children availed of GP services and availed of these services more often once they gained free access. Our study also demonstrates the ‘knock-on’ effect of the under 6s contract in the out-of-hours service, which experienced a disproportionately large spike in numbers of children under 6 attending.”

“GP services in Ireland are getting busier in general, and this was also demonstrated in this study, with GPs seeing more patients of all ages in the second year of the study. However, almost half of additional visits to the daytime services, and three quarter of the additional visits to the out-of-hours service were generated by the under 6s. As we have no reason to believe that the cohort experienced more ill health in the second year of the study, we can conclude that the large increases were simply as a result of the introduction of free GP care.”

Professor Tom O’Dowd, Fellow Emeritus, Public Health & Primary Care, Trinity, added: “This study shows that workload planning is required when any changes to GP access are made. If not, access to front line GP services will be undermined for everyone.”

Key findings:

1              Daytime GP consultations

• There was a 29% increase in the number of consultations by children under 6 years of age at daytime GP services. These additional consultations resulted from two factors :

a) 9% more patients attending their GP at least once in the year following the introduction of free care, and

b) an increase in average consultation rate. On average, children under 6 attended their GP 3.25 times a year following the introduction of free care, up from 2.77 times a year in the pre-period.

2              Out of hours consultations

• There was a 26% increase in the number of individual visits by children under 6 years of age to the GP out-of-hours service.
• These additional visits to out-of-hours services were the result of 20% more patients attending a GP out-of-hours service at least once a year combined with an overall increase in average consultation rates, with children under 6 on average attending out-of-hours services 1.59 times a year following the introduction of free care, up from 1.52 times a year in the pre-period.

3              Disproportionate increase in visits from under 6 cohort

• Both daytime and out-of-hours GP services were busier in the second year of the study, but almost half of additional visits to the daytime services, and three quarter of the additional visits to the out-of-hours service were generated by children under 6 years of age.

Dr Michael O’Callaghan concluded:  GP services in Ireland are under severe pressure at the moment and this study identifies important drivers. Further expansion of free GP care will lead to increased utilisation, which will have significant implications for daytime and out-of-hours GP services. Such increased utilisation could destabilise Irish general practice as it exists at present. There will be knock on effects for emergency departments and hospitals. Patients know that GPs who are not accessible cannot be effective providers of community based care.”

The paper ‘Free children’s visits and general practice attendance’ by Dr Michael O’Callaghan, Dr Lina Zgaga, Dr Darach O’Ciardha, Professor Tom O’Dowd can be viewed and downloaded here: http://www.annfammed.org/content/16/3/246