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