IRISH MEDICAL ORGANISATION

1. IRISH MEDICAL ORGANISATION Presentation On Review Of GMS And Publicly Funded Primary Care Schemes Dr Martin Daly Chairperson IMO GP Committee 16th November 2005

2. BACKGROUND • GMS Scheme now 33 years old • Repeatedly modified by successive memos and circulars • Existing contract model has served GPs and patients well but has failed to evolve in line with GP and societal needs

3. STRENGTHS OF CURRENT SYSTEM High patient satisfaction Equal access for Public and Private patients Same-day service Flexibility in responding to health crises as they arise Value for Money!

4. Contd.. Strengths Of Current System 24 hour 7 day service, 365 days per year Extensive network of GP centres of practice Easily accessible service

5. WEAKNESSES OF CURRENT SYSTEM Failure to expand the contract to support Preventive Medicine and Chronic Illness Care Inadequate and uneven access by GPs to essential diagnostic services Failure to adequately support infrastructural development Failure to adequately resource support staff

6. Contd.. Weaknesses Of Current System Lack of flexibility in accommodating changing practices in the workplace Inadequate support to allow GPs to take sick leave, maternity leave and study leave in line with public service norms Lack of uniform out of hours service

7. 1972-2005 CHANGED LANDSCAPE! Changes in GMS population served Changes in GP workload Changes in GP service delivery Changes in GP age, gender and career expectations

8. CHANGES IN GMS POPULATION SERVED Scheme was designed and costed on the basis of a community-rated means tested scheme with even mix of sick and healthy and designed to cater for episodic illness

9. Contd.. Changes In GMS Population Served Since 1989 : • Frontloading with individual high-need patients at discretion of CEOs (? 80,000) • Non-EU Nationals/Asylum Seekers • Cancer patients, Hepatitis C, Foster Children • Inclusion of all over 70s • GP Visit Cards with greatly reduced entitlements

10. CHANGES IN GENERAL PRACTICE WORKLOAD People living longer More chronic disease Escalating administrative burden Evidence based disease management “Offloading” of workload from the hospital sector (Warfarin, Psychiatry etc.)

11. Contd.. Changes In General Practice Workload Increasingly litigious society Higher patient expectation Imperative for more CME/CPD Demands for GP representation on countless committees, PCTs, interview boards, working groups etc.

12. CHANGES IN GP SERVICE DELIVERY • Improvements in standard of premises • More ancillary staff employed • Widespread adoption of ICT • Shared care (Heart-watch, Mother and Infant Scheme, Diabetes etc)

13. CHANGES IN GPS’ AGE, GENDER AND EXPECTATIONS Fewer newly trained GPs committing to whole time General Practice Aging GP population in many areas Greater demand for flexible contracts Difficulty accessing locums

14. Contd.. Changes In GPs’ Age, Gender And Expectations Changed expectations in younger GPs: Less interested in single-handed practice Less interested in working in rural areas Less interested in working in deprived urban areas

15. A NEW CONTRACT – FIRST PRINCIPLES • Patient is paramount • Any new contract has to deliver a service more suited to the needs of the general public going forwards • Needs of the State and of General Practice must also be satisfied

16. Contd.. A New Contract – First Principles Win-win elements should be identified and dealt with as early in the process as possible to engender trust and assist progress

17. PUBLIC-PRIVATE MIX GPs look after 100% of the population, while the GMS extends to < 30% of the population The state currently has no contractual relationship with GPs in respect of the other 70% of the population, other than through the Mother & Infant Scheme and the Primary Childhood Immunisation Scheme Preventive and Chronic Illness schemes should be available on a whole-population basis with appropriate contractual arrangements

18. Contd.. Public-Private Mix Recognition that there are 2 distinct populations with very distinct eligibility The State should not assume a remit over the provision of the totality of GP care to those citizens outside the GMS unless and until relevant contractual arrangements have been negotiated

19. PRIORITIES FOR GENERAL PRACTICE Infrastructure Service Issues Contractual Issues Universal Patient Registration

20. PRIORITIES FOR GENERAL PRACTICE Infrastructure • Imaginative approach to the funding of necessary GP capital infrastructure • Realistic support for current infrastructure costs, such that these are not provided at a net cost to GPs (staff, ICT, diagnostics….)

21. PRIORITIES FOR GENERAL PRACTICE Service Issues • Need for realistic funding of: • Expanded range of special items of service (e.g. 24 hr BP monitoring, minor surgery, joint injection) • Chronic Illness Schemes (e.g. Diabetes, CHD, Asthma/COPD, Anticoagulation)

22. PRIORITIES FOR GENERAL PRACTICE Contd.. Service Issues • Need for realistic funding of: • National Preventive Programmes (e.g. Cervical Screening, CVS Screening) • Age-appropriate annual check-ups • Proper uniform access to community diagnostics (e.g. near-patient testing, Dexa scanning, Ultrasound), as well as hospital-based diagnostics

23. PRIORITIES FOR GENERAL PRACTICE Contract Issues Flexibility of contract Out-of-Hours CME – CPD Representation GMS entry & exit Pensions

24. PRIORITIES FOR GENERAL PRACTICE Universal Patient Registration • Can significantly improve practice for GPs and patients • Needs proper funding and ICT support • Data Protection and other safeguards required

25. SUMMARY Timely Review Interests of 3 Parties Ensured Modern Service Demands Modern Infrastructure Shift From Secondary Care Continuance of High Quality

26. Contd.. Summary Continuance Of A Culture Of Equity In General Practice Must Be Attractive To Patient Must Be Attractive To Doctor Must Be Attractive To Government The IMO Is Committed To This Process