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According to the Organisation, which has membership across hospital, general practice and public and community health settings, the proposal to introduce free GP care to the whole population over five years is “not achievable given current problems of capacity and funding in general practice”.
It also describes as “startling” that the report does “not recommend significant increases in bed numbers and instead offers unworkable and simplistic solutions to the capacity problem”.
The report fails to “prioritise recruitment of consultants to tackle chronic shortage across the system”.
According to the IMO, the proposal to end the provision of care to private patients in public hospitals as a means of increasing capacity in public hospitals demonstrates “a fundamental misunderstanding of the operation of the hospital system”.
IMO President Dr Ann Hogan commented: “The report contains many useful proposals but its credibility is seriously undermined by a failure to recommend realistic funding in respect of many of the principles of the report.”
She added: “We can all agree that healthcare should be delivered on the basis of need rather than ability to pay and that, in an ideal world, such a system would provide all care on a universal basis which is free at the point of access. However we do not believe this report will in fact deliver upon that goal given the wholly inadequate funding and capacity recommendations. In particular the failure to sufficiently and credibly address the capacity issue across the services both in terms of staffing and infrastructure is a major flaw. Unless and until we have the basic elements required to deliver a functioning health service in place in the short term we cannot seriously commit or even aspire to delivering a universal system in either the medium or long term.”
Dr Hogan continued: “The overriding objective of each and every doctor in our health services is to deliver the best possible care to each and every patient. We, along with our colleagues in the health services, are charged with delivering that care and it is our duty to advocate for change that will make a real difference to patient outcomes and to the development of our public health service.”
Meanwhile, the NAGP cautioned that the report could only be implemented by restoring viability to general practice through reinvestment and the successful negotiation of a new GP contract.
The NAGP welcomed the Committee’s recognition that “existing capacity is exhausted” in general practice and “capacity must first be addressed”. The Association called for immediate resourcing of general practice to restore functionality and viability. “This can be partially addressed through unwinding the disproportionate FEMPI cuts imposed on general practice – a process now formally underway for other health sector workers but from which general practice is currently excluded,” stated the NAGP.
The NAGP said the negotiation of a new GP contract must be accelerated with the equal involvement of all the parties, or implementation of the report will not happen.
Dr Emmet Kerin, President of the NAGP, commented: “I’d like to thank the Oireachtas Committee on the Future of Healthcare for its dedicated work over the past year to deliver a 10-year plan for health care in Ireland. This report will help take politics out of health and give direction and clarity to the decisive shift to primary care that is required to redress our current failed hospital-centric model of care.”
However, Dr Kerin warned: “Progress on a new GP contract has been too slow and fragmented. At the current rate, we are unlikely to see a new contract agreed within three years. A new fit-for-purpose contract would underpin much needed reform in our primary care health service. Failure to produce a timely new contract would be an unforgiveable obstacle to the delivery of the vision set out in this report.
“Progress on the contract has been very slow and is not helped by the parallel negotiation processes taking place which has only served to create more silos. The NAGP warned that this approach would not be in the best interests of GPs or patients and we repeat our stated position that we would prefer that all parties to negotiations were in the same room and there was an agreed time-frame to deliver a contract. We must ensure that we all play our part equally in delivering the health service that patients deserve. I am calling on the Minister for Health to bring GP contract negotiators into the same room and remove the barriers to meaningful progress that the parallel process has created.”
The NAGP welcomed principles that have been highlighted in the report, including more care for patients delivered in the community; implementation of an integrated care system; enhanced teams working in primary care with GP leadership; better access to community diagnostics through service hubs; and ring-fenced transitional funding underpinned by legislation
Dr Kerin added: “There are many positives in this report and many challenges. There will not be 100 per cent agreement on certain recommendations. Extension of free GP care over five years, while utopian, will currently destabilise an exhausted service, already working beyond safe capacity, unless realistic funding, manpower and infrastructural supports are front-loaded into general practice and agreed by all the parties from day one. The near-universally negative GP experience of the introduction of free GP care for under sixes is a barrier to the implementation of this report as the day-time and out-of-hours service was overwhelmed not by ‘unmet need’, as stated by the Committee, but by unyielding demand for free access for minor self-limiting conditions of low acuity which displaced access and clinical time for more appropriate GP consultations, including the sick and frail elderly. This added to the trolley crisis of 2015/16. Such ‘unmet need’ displaced real need in our more vulnerable patients. This was, and remains, bad medicine and is far from the person-centred care which is meant to respect all providers and patients equally.”
Dr Kerin also asked the Committee and the State “to seek an independent impact analysis on the separation of private practice from the new, publicly funded, free-GP scheme to avoid and limit any unintended consequences that may arise to patients and providers from this separation”.
Separately, the ICGP, the professional and training body for Irish family doctors, has welcomed the publication of the report and its focus on the central role of primary care.
The College warned, however, that whilst free GP care for all is a laudable policy – and one that has broad political support – this policy cannot be delivered without a significant increase in the number of doctors, practice nurses, administrative staff and physical infrastructure in primary care to cope with increased demand.
The World Health Organisation has stated that Ireland is “unique among EU countries in not providing universal coverage of primary care”, added Dr Karena Hanley, National Director of GP Training. “We know that patients ability to pay affects their ability to access diagnostic tests, for detecting cancer, for example.”
“Currently, it is the norm that patients can see their GPs on a same-day basis, and those with medical cards, as well as the under 6s and over 70s, can see their family doctor when they need to,” said Dr Mark Murphy, Chair of Communications with the ICGP. “However, our concern is that free GP care for all could lead to waiting lists for GP appointments if increased capacity is not urgently delivered, and create a two-tier GP system, where only a private GP service could deliver a same-day appointment.”
“The Government needs to understand that we are already experiencing difficulties in filling training places for family doctors, and that some medical card lists cannot be filled; getting a locum (replacement) doctor to enable holidays or sick leave is also a problem for many practices,” added Dr Murphy. “We need to make General Practice a more attractive option for younger doctors, and ensure that set-up costs and barriers to establishing new practices are removed.”