Chair of the IMO GP committee Prof Tadhg Crowley outlines what GPs can expect to hear at the upcoming AGM.
As GP members meet in Killarney for the IMO AGM, a number of important topics affecting general practice will be discussed. Members will hear presentations on the need for a resourced obesity programme in general practice, as well as a dedicated wrap-around women’s health programme. Current and future developments in the e-health space will also be discussed and, in particular, the need to ensure that such developments increase rather than reduce patient facing time. In addition, there will also be a focus on the new HSE Health App, e-prescribing and shared care records among others.
In relation to the resourced obesity programme, we have heard much commentary on the benefit of GLP-1 drugs, such as Ozempic. Without doubt these are groundbreaking medications; however, the reality is that for the best outcomes patients need a structured programme in general practice to give advice on improved lifestyle, adherence to medication and monitoring, with twice-yearly check-ups. This is to ensure that the patient gets the best outcome from the medication and can also make lifelong, sustainable changes to their lifestyle to ensure overall better health outcomes. Medication in isolation is not the solution.
Women’s health
The recent Programme for Government set out its intentions to:
“Provide a comprehensive women’s health programme in general practice including advice on contraception, sexually transmitted infections, screening, fertility and pre-conception and support for women experiencing menopause”.
This can be delivered in general practice if it is resourced properly and would be of significant benefit to our female patients. The IMO have long called for a wrap-around women’s health programme in general practice and we are open to entering into discussions with the State on providing such a service. This should be a specific, structured programme with the patient at its centre. Women’s health services in this country are, to my mind, far too fragmented with specialist menopause services (often with long waiting lists), specialist fertility advice and other disparate elements. Bringing this all together to be delivered by the patient’s GP would be of great benefit to the patient and ensure continuity of care rather than the current patchwork of different services.
E-health
One of the big changes in general practice over the last number of years has been the increase in e-health initiatives. GPs have always been to the forefront in adopting technology and were the first medical practitioners to use specific practice management software. Practice management systems are funded by the GPs themselves but they have now been utilised to build further upon and integrate with HSE systems.
The IMO was central to this and a number of e-health measures were set out in the landmark 2019 GP deal agreed between the IMO, HSE and Department of Health. They include the introduction of individual health identifiers, e-referrals; e-prescribing; the National Integrated Medical Imaging System; e-ordering/MedLis; summary and shared care records; integrated immunisation systems; and the use of Healthlink and Healthmail.
While some of these developments are now fully integrated into general practice, others are still in their infancy or indeed in some cases yet to commence. The most noteworthy of these will be the shared care record which will utilise agreed GP practice management systems to populate an e-health record for each patient. This would be securely stored and could be accessed by other health professionals. Over time, hospital systems would also add to the shared care record, giving a more complete picture of the patient’s care.
Much of this is mandated through the Health Information Bill which has yet to pass through the Dáil and through European legislation on the e-health space.
While there are great advantages to IT developments, the IMO GP committee is extremely conscious of the need to ensure that any developments do not increase workload on general practice. The most important time for a GP is the time they spend facing their patient and this must be maintained to the greatest extent possible. There is always the danger with a new development that, in order to generate more data, more of the GP’s time is spent on administrative tasks at the expense of clinical work. Given the already significant deficits in GP capacity, this must not be allowed to happen. Data should be auto-populated from the GP record where possible. Good design aids good clinical practice, as we have seen in the chronic disease management programme, negotiated by the IMO as part of the 2019 deal. This allows for electronic return and largely works well with the population from the record. The IMO continues to work closely with the HSE on e-health measures and impress this overriding principle in all our dealings with them on these issues.
App
Another recent development is the HSE Health App. This is not a GP application and GPs do not need to interact with the app. The IMO has agreed to the same data which is to be utilised for the summary care record to be used for the HSE app. We have met with the development team and stated that this is not a GP app. For GPs to access this data, they will use the shared care record when developed – the app is a tool for the patient and may have some uses in secondary care appointments if the HSE wishes to develop it in this manner. But the GP is not obliged to interact with it. Data should be pulled from the GP system, using the agreed fields from a date agreed with the IMO. The IMO will brief members well in advance of this.
All in all, we have a full agenda for the AGM in Killarney and the above is just a snapshot of some of the issues we will be talking about during our own GP national meeting. Across the three days. there will be many other interesting meetings and speakers and we look forward to lively discussion and debate as ever on the issues affecting general practice and the health service more generally.
The IMO AGM takes place on 24-26 April in The Europe Hotel, Killarney, Co Kerry
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