1. The Case For FEMPI Restoration & IMO Strategy
Dr Padraig McGarry
Chairman,
IMO GP Committee

2. The Second Cut is the Deepest
2009- €34m 8% reduction in Fees and Allowances
2010- €46m Removal of distance coding, reduction in Fees
2011- €6.7m Reduction in Immunisation Fees
2013- €38m Reduced Weighting for Over 70s and in Fees
NO ACCOUNT OF FACT THAT FEES ARE NOT PROFIT
NO ACCOUNT OF FIXED COSTS ASSOCIATED WITH SERVICE

3. IMO Submissions – Warnings on Inevitable Consequences
No Service/Infrastructural Development
Contraction of Existing Services
Elimination of Pro Bono practices/services by GPs
Rural Practice unfairly targeted
Retention of existing staff at risk
Attraction of specialty diminished
ALL ABOVE HAS COME TO PASS

4. What has IMO done about FEMPI?
Detailed submissions/lobbying/media engagement on FEMPI and affects on GP Services
Legal v legislative position
Competition Authority Settlement which allowed negotiation
FEMPI process in Memorandum of Understanding
Engagement with Department of Health, HSE, Department of Expenditure and Public Reform
NO concession that new contract provisions will negate FEMPI
NO concession that new funding for new work will be part of FEMPI restoration

5. THIS IS THE CRITICAL POSITION TO DRIVE THE FEMPI AGENDA
IMO Position
Provisions as outlined in MOU must commence immediately:
Under the MOU agreed between the IMO, Department of Health and the HSE it is agreed that in line with negotiations with public sector unions on an orderly unwinding of FEMPI, a similar process will be put in place involving the IMO, Department of Health and the HSE in relation to the application of the FEMPI legislation to GPs since 2009
THIS IS THE CRITICAL POSITION TO DRIVE THE FEMPI AGENDA

6. IMO Position Provisions as outlined in MOU must commence immediately
Public Sector negotiations now concluded with roadmap for restoration – time for same for GPs
Current position unsustainable in terms of finances, infrastructure, manpower and patient services
New workload cannot be undertaken without a roadmap to address FEMPI
FEMPI issue is obstacle to reforming the way services are delivered to patients .

7. IMO Strategy If you want to win the game, you have to be on the pitch
Following settlement agreement with Competition Authority – Framework Agreement with Department and the HSE, IMO entered into negotiations on under 6s on the condition that negotiations would then take place on a new overall GP contract with a provision that GPs would be entitled to same FEMPI process as public servants.
IMO have negotiated agreements and funding of up to E120m in relation to Under 6s and :
Diabetic Cycle of Care for GMS Patients €10 million
Rural Practice Support Framework (100 extra practices and 25% increase) €10 million
24 Hour ABP (new)
LARC (new)
Increase in Suturing Fee (doubled from €24.80 to €50)
Increase in Bladder Catherisation Fee (€37.21 to €60)
New agreement on Primary Immunisation Schedule (20% increase)

8. IMO Strategy
IMO now in negotiations of Phase 1 of new contractual provisions.
Negotiations are dependent on:
Funding commitment for NEW work
Roadmap for restoration of FEMPI for EXISTING services
General Practice needs a twin track approach to deal with ongoing provision of existing services and the PHASED introduction of new workload – No capacity to do otherwise

9. FEMPI Restoration for Public Servants
Earning above €110,000 Gross
2013 FEMPI Cuts being restored in three tranches – September 2017 to September 2019
2011 FEMPI Cuts partially restored under new Public Sector Agreement up to 2020 with balance likely to be restored by 2022
2009 FEMPI Cut was a Pension Related Deduction – this will not be restored and is now a permanent additional contribution of 10% by employees

10. FEMPI Restoration – What’s needed v What’s achievable
Full reversal of all FEMPI cuts immediately
However much we need and want this it is unlikely that up to €160m will be restored to GPs in one tranche
What’s Achievable and MUST be taken on board by Government
Roadmap setting out year on year restoration measures that will give GPs confidence and the ability to make business decisions with regard to their practice having certainty around future fee increase.

11. FEMPI and a New GP Contract
Restoration of FEMPI and New Contract provisions are inextricably linked
IMO negotiating NEW service provisions which need NEW funding and cannot be funded from existing resources or from FEMPI restoration

12. FEMPI and a New GP Contract
Everything must be done in phases unless or until there is sufficient funding available to resource appropriately
TO DO OTHERWISE WILL BE TO SELL OUT GENERAL PRACTICE AND GPs
IMO AND ONLY IMO ARE NEGOTIATING FOR GPs and FOR A VIABLE FUTURE FOR GENERAL PRACTICE

13. AND…. While I am here GP CONTRACT NEGOTIATIONS UPDATE
IMO, Department of Health and HSE have been engaged in negotiations since February 2017
Full negotiating meetings every two weeks – additional clinical and technical sub group meetings
IMO supporting vision to move services from secondary to primary care BUT only as sufficient funding becomes available

14. GP Contract Negotiations Update
IMO Position
General Practice is underfunded with problems in capacity and infrastructure
FEMPI must be dealt with under MOU
New work and new contract obligations can only be introduced as resources become available
Transfer of workload from secondary care to GP can only happen in planned and phased way
Universal GP Care is aspirational at best
General Practice must be a sustainable and viable career for all

15. GP Contract Negotiations Update
Past months have focused on priorities for Phase 1:
Process for restoration of FEMPI
Chronic Disease Management
Capacity Measures – staffing arrangements/redundancy
New Special Items of Service
Ehealth and supports for IT
Medicine Management Initiative – support for Infrastructure

16. GP Contract Negotiations Update
Current Situation:
Under Framework Agreement we have now moving to the stage of negotiating details of resourcing
Need clarification from Department and HSE on what funds are available following Budget on October 10th
We can only move to further phases as agreement is reached and resources in place for Phase 1
We are not in negotiations on under 12s/ under 18s – IMO position in this regard is clear – not possible in current funding and capacity environment

17. Conclusion The IMO: Has a vision for the future of General Practice
Has a strategy to deliver on that vision
Strong negotiators and committed members
Working towards a sustainable General Practice