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A crossroads for general practice and the NAGP

It has been a very busy year for the NAGP. Since the AGM in May last year, the Association has contin­ued to strongly campaign for the rights of its members and for a better deal for general practice in Ireland.

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Mr Chris Goodey, CEO, NAGP

Concern is rife regarding the fu­ture of general practice in Ireland, as difficulties in attracting GPs to take up GMS positions, particular­ly in rural and deprived urban are­as, continue.

When the NAGP relaunched in 2013, it did so amidst an atmos­phere of unrest and despair among GPs following a 40 per cent cut to gross income under FEMPI and broken promises on the creation of a new GMS contract. General practice trainee roles in Ireland, once hugely sought-after and high­ly coveted, were fast becoming un­attractive as uncertainty about the future of the profession abounded.

It is now 2018, and has anything changed? If anything, many would say the situation has actually wors­ened. But the NAGP, now with 2,059 GP members, says it is ac­tively striving to change this.

Contract talks

To date, there has been no ma­jor development in GP contract negotiations, which are still mov­ing at a snail’s pace, despite Gov­ernment promises to the contrary. The NAGP confirmed to the Med­ical Independent (MI) that it has not had a direct meeting with the Department and HSE regard­ing the contract since last October.

MI revealed last December that the NAGP had held eight ‘consul­tative meetings’ on the contract with the Department and HSE in 2017, while the IMO had 17 formal meetings and a number of informal meetings by the end of November.

NAGP CEO Mr Chris Goodey confirmed that following a four-month hiatus in GP contract ne­gotiations, the NAGP recently re­ceived communication that negoti­ations would recommence shortly.

“We have been assured that the concerning delay is due to person­nel changes within the HSE and Department of Health,” Mr Good­ey said.

However, GPs have already wait­ed far too long for a new contract to be put in place, he acknowledged.

“I think having to wait anoth­er two or three years for a contract could potentially break general prac­tice; it’s already at a tipping point, so we will continue to campaign heavi­ly on that,” Mr Goodey said.

“We would have preferred to see more progress on a new contract, but hopefully this year there has been various and ongoing change at the HSE and Department of Health and perhaps this year things will get a bit more focused.”

Since the last AGM, the Associ­ation has carried out a detailed le­gal analysis of the current GMS con­tract and developed an information poster arising from this process, which spanned three months.

“The legal analysis has taken a huge amount of time and work, looking at the contract and what GPs are obliged to do. We did an analysis of the contract and it states what GPs are obliged to pro­vide as a service — if you want to go about additional services that’s up to you — and if you want to charge for additional services, that’s up to you,” Mr Goodey explained.

Outgoing NAGP President Dr Emmet Kerin, in reference to the legal analysis, said that GPs are looking for leadership and have exhausted all diplomacy and po­litical interactions.

“I think there will be a certain amount of self-realisation among GPs that they will have to really start working to their contract and looking at what they can safely pro­vide. It all comes back to patient safety… Membership is screaming at this stage that they would like to get direction about what to do. Ob­viously it has to be within the letter of the law; we can’t instruct people to withdraw services, but we can rationalise what it is we are pro­viding while remaining safe to our patients and protecting doctors’ health and practice staff,” Dr Ker­in argued.

Objectives

According to Mr Goodey, the As­sociation’s two main objectives for the next 12 months are the imme­diate reversal of FEMPI and the in­troduction of a new GP contract.

GPs must wait a little longer for the anticipated reversal of FEMPI measures, announced last Novem­ber by Minister for Health Simon Harris. Much to the ongoing frus­tration of GPs, the FEMPI reversal process will not begin until 2019.

Mr Goodey believes it is unaccep­table that GPs be expected to wait until 2019 for the reversal of FEMPI.

GPs have been very patient, but understandably, their patience is waning of late.

Mr Goodey reports that a “mas­sive increase” in burnout among GPs has occurred, with a jump in the numbers of GPs suffering from burnout contacting the NAGP for support in recent months.

“It’s been a very challenging year for general practice and we’re see­ing an increasing amount of burn­out among GPs around the coun­try, which is as a result of the in­creasing workload. I was recently at a conference in England where the Chairperson of the GP Committee at the British Medical Association said that there were a thousand GPs currently suffering from burnout in the UK. I would think that we’re very close to those figures ourselves here,” Mr Goodey said.

“I think this will be one of the motions at the AGM, to try and put in place a support mechanism for GPs who suffer from burnout… there needs to be further supports put in place for GPs because I think this will be a major issue in 2018.”

Dr Kerin also highlighted the growing issue of burnout and doc­tor ill health among Irish GPs.

“By nature of the profession, GPs tend to ‘suck it up’ a lot and are very flexible and tend to go the extra mile for patients; that’s who GPs are by nature. If you look back a few years ago, many GPs would be uncomfortable about being pub­lic and talking to the media, but that’s changed now. I’m starting to see many patients recognising that the service is very much strained,” Dr Kerin said.

Commenting on recent concern from GPs about the HSE placing dangerous, violent offenders on­to their lists without warning of their history, Dr Kerin reiterated his call for a specific ‘violent pa­tient scheme’ (reported in MI last issue), similar to that in operation in the NHS, to be established.

“Violence towards doctors is a very rare occurrence but it’s poten­tially a dangerous occurrence and I think that is something I will table a motion on at the AGM,” Dr Ker­in remarked.

The motions have yet to pub­lished, but are to be finalised at a meeting this week.

Dr Kerin believes that one of the dominant issues will be the GP out-of-hours service.

Turmoil

The NAGP has also seen some turmoil within its ranks in recent months.

As previously reported by MI, its campaign to increase awareness on the EU Cross-Border Healthcare Directive caused some GPs to raise medico-legal concerns about refer­ring patients to recommended hos­pitals abroad and to query if there were financial links between the Association and the hospitals and a referral company mentioned in its campaign leaflet. The Associ­ation has denied any financial in­centives are involved and insists that its motivation is to help pa­tients access care in a timely man­ner, in light of the current excessive hospital waiting times in the HSE. It referred to a number of cases where patients had been able to ac­cess care very quickly under the Di­rective, and confirmed it will have an information session on the Di­rective during the AGM.

A number of the NAGP’s Na­tional Council and National Exec­utive members have also resigned recently, including Vice President Dr Yvonne Williams, who was due to take on the role of President at the AGM.

Mr Goodey said Dr Williams stepped down for personal rea­sons. Speaking to MI, Dr Williams confirmed her resignation but said: “I am unable to make any fur­ther comment at this time.”

A proposal for the NAGP to have two co-Presidents in situ was de­bated at a recent meeting of NAGP Council and Executive members following Dr Williams’s resigna­tion. At the meeting, Mr Good­ey said that introducing a “co- President” situation was decided against and that a new President was decided upon, with details to be announced at the AGM.

The Association’s National Ex­ecutive member and Chair of Com­munications Prof Liam Glynn stepped down in recent months due to his new work commitments as Deputy Head of the University of Limerick Graduate Entry Med­ical School.

Mr Goodey also confirmed that GPs Dr Lucia Gannon and Dr Shane Corr recently resigned from the National Council for personal reasons, and some others are like­ly to step down by the time of the AGM due to work commitments, making way for new blood.

Mr Goodey revealed that the num­ber of positions on the NAGP Coun­cil and Executive would increase from a total of 19 to 22 this year, meaning that there are at least seven vacancies to be filled. The new mem­bership of the Executive and Council will be announced at the AGM.

In addition, some NAGP mem­bers have raised concern about the Association’s financial position and spending. Its financial year does not end until 31 March, so its latest financial accounts will not be ready for the AGM, Mr Goodey confirmed (see news story on page 3 for further details).

Meanwhile, the NAGP is due to meet with the Competition and Consumer Protection Commission this week. The Association recent­ly launched a three-vote phone bal­lot campaign of its membership, which could have potential compe­tition law implications.

The first ballot, issued in Janu­ary, asked members “should the NAGP recommend to its mem­bers to revise their existing par­ticipation in the out-of-hours ser­vices commensurate with patient safety concerns and to comply with the existing European directive on hours worked by doctors?”

The ballot was taken by SMS and in total, there were 1,830 messag­es delivered. The NAGP said the re­sult showed that 84 per cent of re­spondents are in favour of revising their existing participation in GP out-of-hours services.

Mr Goodey said that the meet­ing with the Commission is being held to establish the NAGP’s legal parameters in terms of its ballots.

“We have taken legal advice on our ballot but we’re meeting with the Commission to ensure they’re comfortable with our process,” Mr Goodey said.

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Dr Emmet Kerin, President, NAGP

Last week, following a delay, the NAGP issued its second ballot question: Should the NAGP prior­itise a) new contract negotiations, or b) the reversal of FEMPI?’

Agenda

Turning to the NAGP’s AGM it­self, this year’s agenda is jam-packed with presentations and ses­sions on a huge variety of political and clinical topics, as well as mem­ber motions and business.

The first day of the two-day event will examine issues includ­ing the EU Cross-Border Health­care Directive, ophthalmology and joint injections.

A panel discussion, titled ‘Sláinte­care: Where now?’ will take place, with Fianna Fáil Health Spokesper­son Deputy Billy Kelleher, Dr Paul Grundy, and Dr Kerin scheduled to participate.

An evening dinner is planned, with a presentation of the Dr Francis Rynd Innovation Award scheduled.

The second day will see sever­al topics discussed, including data protection, risk in general practice and asthma control.

Renowned international speakers with vast experience in healthcare will deliver the two keynote speeches.

Dr Grundy, who is in Ireland for five weeks from the end of Febru­ary to work with the NAGP to help it formulate a response to Sláintecare, will deliver the first keynote address.

Dr Grundy is an honorary mem­ber of the NAGP and is also a healthcare ambassador for the na­tion of Denmark, but is perhaps best known as the founding Presi­dent of the Patient-Centred Prima­ry Care Collaborative (PCPCC).

The next keynote address will be given by Dr Jack Cochran, author of the book The Doctor Crisis: How Physicians Can, And Must, Lead The Way To Better Healthcare. Dr Cochran will discuss healthcare transformation, a subject of huge interest to the US-based doctor, who spent more than two decades working as a plastic surgeon.

“I think it will be a very lively AGM,” Mr Goodey said.

The NAGP AGM takes place at the Clayton Silver Springs Hotel, Cork, on 2-3 March. For the full agenda and to register, go to www. nagp.ie.

Additional reporting by Priscil­la Lynch.

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