The current GP contract negotiations should “commit clearly” at an early stage to the removal of compulsory out-of-hours (OOH) working for GPs, according to the NAGP.
In its submission to the HSE Primary Care Division GP Out of Hours Review Group, the association said the budget for OOH should be negotiated separately from the core contract.
According to the NAGP, the negotiations should simultaneously commit to the concept that the optimum model for OOH care is via GP-managed co-ops.
The NAGP also says the Department of Health must commit to other OOH services such as palliative care, forensic care, nursing home care and dental care, as examples.
Other proposals are that GPs who opt to work solely OOH should have access to a clear pension structure, to be negotiated; GP co-ops should look to upskill other healthcare staff so that less complex cases can be dealt with under the supervision of, but not directly by, GPs; new models of consultation such as telemedicine should become core components of new, more efficient, OOH services; economies of scale savings should be looked for throughout the service generally.
“Many of these [proposals] are of the utmost urgency both to preserve a viable out-of-hours service but, more importantly, help stabilise daytime general practice.”
Compulsory out-of-hours work, let alone a 24/7 contractual commitment, does not feature in the any of the other countries healthcare systems to which they are being actively recruited, noted the association’s submission.
The NAGP added that the current model will not be viable for much longer for three reasons: the demographic of existing GPs is “now too old” to continue to carry this burden of work; newly qualified Irish GPs are “simply not willing” to work within a system “with such an onerous work commitment”; the increasing challenge of day time general practice as an older more complex patient demographic continues to emerge places hugely increased demands on GPs.
“The experience of co-ops in dealing with the introduction of the under-six medical card highlighted the increase in workload by as much as 60-70 per cent as doctors feared. The under-six card has completely sapped morale in general practice and any future changes must seek to avoid the same mistake,” it added.