IRISH MEDICAL ORGANISATIONPresentation On Review Of Presentation On Review Of GMS And Publicly Funded GMS And Publicly Funded Primary Care SchemesPrimary Care Schemes

Dr Martin DalyChairpersonIMO GP Committee

16th November 2005

BACKGROUNDBACKGROUND

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

STRENGTHS OF STRENGTHS OF CURRENT SYSTEMCURRENT 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!

Contd.. Contd..

Strengths Of Current Strengths Of Current SystemSystem 24 hour 7 day service, 365

days per year

Extensive network of GP centres of practice

Easily accessible service

WEAKNESSES OF WEAKNESSES OF CURRENT SYSTEMCURRENT 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

Contd.. Contd..

Weaknesses Of Current Weaknesses Of Current SystemSystem 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

1972-2005 1972-2005 CHANGED LANDSCAPE!CHANGED LANDSCAPE! Changes in GMS population

served

Changes in GP workload

Changes in GP service delivery

Changes in GP age, gender and career expectations

CHANGES IN GMS CHANGES IN GMS POPULATION SERVEDPOPULATION 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

Contd.. Contd..

Changes In GMS Changes In GMS Population ServedPopulation ServedSince 1989 :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

CHANGES IN GENERAL CHANGES IN GENERAL PRACTICE WORKLOADPRACTICE WORKLOAD People living longer

More chronic disease

Escalating administrative burden

Evidence based disease management

“Offloading” of workload from the hospital sector (Warfarin, Psychiatry etc.)

Contd.. Contd..

Changes In General Changes In General Practice WorkloadPractice 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.

CHANGES IN GP CHANGES IN GP SERVICE DELIVERYSERVICE DELIVERY

Improvements in standard of premises

More ancillary staff employed

Widespread adoption of ICT

Shared care (Heart-watch, Mother and Infant Scheme, Diabetes etc)

CHANGES IN GPS’ CHANGES IN GPS’ AGE, GENDER AND AGE, GENDER AND EXPECTATIONSEXPECTATIONS

Fewer newly trained GPs committing to whole time General Practice

Aging GP population in many areas

Greater demand for flexible contracts

Difficulty accessing locums

Contd.. Contd..

Changes In GPs’ Age, Changes In GPs’ Age, Gender And Gender And ExpectationsExpectations 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

A NEW CONTRACT – A NEW CONTRACT – FIRST PRINCIPLESFIRST 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

Contd.. Contd..

A New Contract – First A New Contract – First PrinciplesPrinciples

Win-win elements should be identified and dealt with as early in the process as possible to engender trust and assist progress

PUBLIC-PRIVATE MIXPUBLIC-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

Contd.. Contd..

Public-Private MixPublic-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

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICE

Infrastructure

Service Issues

Contractual Issues

Universal Patient Registration

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICEInfrastructureInfrastructure 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….)

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICE

Service IssuesService 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)

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICEContd.. Contd.. Service IssuesService 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

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICEContract IssuesContract Issues Flexibility of contract Out-of-Hours CME – CPD Representation GMS entry & exit Pensions

PRIORITIES FOR PRIORITIES FOR GENERAL PRACTICEGENERAL PRACTICE

Universal Patient RegistrationUniversal Patient Registration Can significantly improve practice for

GPs and patients Needs proper funding and ICT support Data Protection and other safeguards

required

SUMMARYSUMMARY Timely Review

Interests of 3 Parties Ensured

Modern Service Demands

Modern Infrastructure

Shift From Secondary Care

Continuance of High Quality

Contd.. Contd..

SummarySummary 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