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Harnessing the full potential of general practice

The theme of this year’s ICGP 2017 Winter Meeting was ‘Harnessing our Abilities’. The subtext was that the training and experience of GPs is perhaps not being utilised to the fullest by the health service. The phrase also speaks to the importance of GPs using all the clinical tools at their disposal to cope with the myriad challenges facing general practice and primary care.

The 2017 Winter Meeting, which took place in Athlone on 17 and 18 November, featured stimulating talks on a wide range of clinical issues. Speaking to the Medical Independent (MI), Director of the ICGP’s Post-Graduate Resource Centre Dr Brendan O’Shea said the event was very well-attended.

“There was quite a lot of standing room only at it. That in itself was very good to see. We understand that general practitioners and practice teams are very stretched as a result of the dreadful decade, from 2007 to 2017, and it takes quite a bit of effort to get out of practice to come to a conference like our Winter Meeting.”

Feedback

On the Friday evening of the conference, a round-table discussion was held, asking members how the College was working from their perspective. The discussion was intended to elicit suggestions about how to improve the experience of  members and also understand the main challenges facing general practice.

“There was a lot of engagement in that. It was very effective,” Dr O’Shea said.

“It was a great exercise in terms of the positive feedback we got. One of the things that is working well is the whole process of education, whether it is happening in CME small groups, whether it is happening through our College e-learning platform… or whether it is happening through our programme of conferences or through our college courses. That was felt to be working really well. The College was also felt to have been effective during the last one-to-two years in terms of our engagement with politics, with the new politics, particularly through the process of our submissions to the Oireachtas and our engagement with other agencies.”

Most of the suggestions for improvements related to capacity issues.

“A really critical issue for newly-establishing GPs is that the CME small groups are packed to capacity. Some of the faculties are very busy,” he stated.

“So it is difficult and challenging for doctors coming out of general practice training to be able to establish themselves in a small group. This is something the College is keenly aware of and we are making a strong case for building further capacity in the CME groups in the relevant places. And it is something we will place even greater focus on in the year ahead.”

Nursing care

On the Saturday morning of the conference, a number of parallel sessions were held and facilitated by the ICGP special interest groups (SIG) on Nursing and Care Home Medicine; Ultrasound Scanning; and Global Health.

The Nursing and Care Home Medicine SIG was formed at last year’s Winter Meeting and there are now 77 GPs who are members of the group. “On the educational front, the feeling was the group has actually been quite successful,” Dr O’Shea said.

“There are three sub-groups within the group — Dr Tim Gleeson is heading-up relationships with external stakeholders. This also was felt to be successful because during the year there was very close engagement between the HSE and Nursing Homes Ireland, and the ICGP SIG. And good work has been done on a principles document that sets out the principles of improving care for people who are resident in care homes. And certainly it highlights the benefits when the engagement between the general practice and the nursing home is effective. And the principles document looks at how to ensure that that happens more consistently.

“General practitioners are really interested in practising good medicine in nursing homes, but there are obstacles that need to be addressed to enable that to happen more effectively than is the case at the moment. And like I say, there has been very good thinking done around this.”

The Ultrasound SIG gave an interactive introduction to ultrasound scanning, from theory to a range of practical applications, including hands-on practice with real patients. It outlined how to set up point-of-care ultrasound in a practice, and how the group will support a GP’s development with this special interest.

Global health

The ICGP SIG on Global Health shared its experiences with delegates and offered signposts for GPs and their practice team on how they can become involved in the area.

“We know from talking to general practice teams, to GPs, to practice nurses, and even to administrators, quite a lot of people in the GP part of the health service have volunteered or are really interested in volunteering and developing health systems,” according to Dr O’Shea.

“It is a complicated area but certainly the SIG that has formed around this has already started to collate quite a lot of really fantastic experience… Within this group it is fairly evident that Dr Martin Rouse and the South East GP training scheme have had a particularly strong and effective level of interest over the last decade. This has enabled GP trainees on this training scheme to spend time in Malawi, in essentially a fairly structured process. And it has been hugely effective; it has added enormously to the learning of the trainees. We do believe it is a benefit to the communities where they are attached and there is very good governance and support around it.”

Challenges

After these sessions, ICGP CEO Mr Fintan Foy spoke about the challenges facing general practice in Ireland. Mr Foy said GP-led primary care must be at the heart of a reformed healthcare system and that the current model centred on hospitals has to change. He stressed how the ICGP welcomed Minister for Health Simon Harris’s recent announcement that his Department will begin to engage on fees for contracted health professionals, including GPs, but was critical of the timescale involved.

“This is the first step in reversing the destructive cuts under FEMPI,” Mr Foy said.

He added that the ICGP is in favour of equitable access for patients on the basis of medical need but it must be ensured that the infrastructure and resources are in place to enable that to happen. Mr Foy cited findings from the recently-published A Future Together report by Prof Tom O’Dowd and his team, which showed that spending in general practice in Ireland is very low by international standards at 4.5 per cent of the overall health budget, and needs to grow if a new contract is to succeed. In addition to the challenge of securing more resources, Mr Foy said a culture of negativity needs to be resisted.

“We talk ourselves into negativity too easily,” he said. “We need to tell the good stories as well; the small successes that bring big changes to an individual’s life; the good stories that never make the headlines.”

Data protection

After Mr Foy’s talk, a discussion was held on ‘Data Protection — Keeping General Practice Ahead of the Curve’, which focused on new data protection legislation reflecting European standards and how this will impact on Irish general practice. This development is the most significant change in the data protection sector since 2011, and the panel included the College’s GP IT leaders.

“The requirements were outlined and interpreted in the context of general practice,” Dr O’Shea stated.

“And that was a pause for thought. But also a plan was set out, which outlined how the ICGP will engage the relevant expertise; how this will be reflected on at the practice level; and how this will be co-ordinated around GP IT. I think delegates got the sense that there is quite a good plan in place for this and when May 2018 comes around, we would expect that general practice would be ready, despite the difficulties. The last round of data protection legislation was in 2011. The College was found to be effective in preparing and assisting practices to be ready for it. And we would use that experience this time round.”

This year’s keynote address was given by Dr Zoe Norris, a GP in East Yorkshire who started writing for The Huffington Post after feeling that the story of what was happening in NHS general practice was not being told. ‘Just a GP’ was the title of her speech. Dr O’Shea said her talk was “hugely engaging, and, at times, provocative”.

The key focus of the talk was about how in the current climate, GPs frequently feel devalued and demoralised. Dr Norris told MI that GPs are often put in a position where they have to try and care for patients in a system that is not designed for the challenges of patients with multimorbidity and “increasing needs means we can be left feeling like we can’t be the GPs we want to be”.

“We face a choice between compromising our own health and wellbeing, and working within the restraints placed on us by an outdated funding formula and the FEMPI cuts,” Dr Norris said.

“To try and solve the recruitment challenges in general practice, we need to take control of what the future looks like. We must demonstrate how skilled GPs are, value ourselves and show politicians that the system simply won’t work without us. We must engage our patients and tell them the reality of what their health service has become. We must ask them to support us by telling their local politicians and Mr Harris that they value general practice and remind ourselves what an incredible, awesome job being a GP is.”

The Winter Meeting also featured clinical updates on Parkinson’s disease, infertility and multimorbidity. Regarding multi-morbidity, Dr O’Shea said: “It is a very interesting and a very timely issue to discuss, given where the key stakeholders are with the general practice contract. So again, there was good attendance and good interest in this. And there was consensus at this workshop that care bundles may have a role to play in helping general practice teams address the level of demand that is clearly implied in an ageing population with multimorbidity.”

Overall, the Winter Meeting had an upbeat feel, despite the many current challenges facing the profession.

“I think many people who attended the conference felt that there was quite a strong level of positivity,” Dr O’Shea concluded.

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