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Minister Donnelly defends timing of strategic review in face of GP criticism

By Paul Mulholland - 16th Apr 2023

strategic review

The Minister for Health Stephen Donnelly has insisted to this newspaper that the timing of the strategic review of general practice this year is appropriate. This is despite continued criticism from GPs that the review should have been conducted before the imminent expansion in eligibility.

Speaking to the Medical Independent (MI), the new Chair of the IMO GP committee Dr Tadhg Crowley branded the decision to hold the strategic review after the expansion in doctor visit cards “a folly”.

Dr Crowley said it was difficult to understand why the expansion was going ahead when the Government recognised there was a significant capacity deficit within general practice.

“They recognise there is a huge problem in general practice, but they are going ahead,” Dr Crowley told MI.

“They are putting the cart before the horse in announcing 500,000 additional cards. Basically, for most GPs, that is an extra session per week to cover those extra visits. It seems a folly.

“But we have no influence other than to say it is a Government decision and we are going to seek mitigation. We are going to fight for our profession. This comes at a time when there are fewer GPs on the ground, increases in chronic disease, increases in obesity, more visits to your GP. We are just recovering from Covid and getting our head above water. This is going to put the system under huge pressure.”

Dr Crowley said the IMO will engage with its members and the Department of Health on the review, which was a commitment under the 2019 GP agreement.

Despite the concerns of GPs, Minister Donnelly said the review was happening at the correct time.

“There are only so many things we can do in parallel,” the Minister told MI. “The big focus from the IMO and from the Department last year was on the consultant contract. The consultant contract is negotiated now and we are moving into a very important review of general practice. No doubt, I think, there will be significant recommendations coming out of that review that we will be looking to implement. Now, I think, is the right time to do the strategic review and then negotiate any changes that are required to the GMS contract.”

In his speech to the IMO AGM on 15 April, Minister Donnelly said latest estimates from the Department of Health predicted that the extension will translate to between three and five additional visits to a GP per week. These figures were subsequently challenged by GPs online.

In recognition of the capacity issues within general practice, the Minister said in his speech that “tens of millions of euro in the budget for this year” had been allocated specifically to provide new support to GPs.

That money was now in the core healthcare budget as recurring annual funding, he added.

“The whole point of the extra resourcing is to acknowledge that the GPs are already working at capacity,” the Minister told this newspaper.

“We are not asking GPs to see their patients more often with the existing resources that they have. What we are saying to the GPs and to the IMO is, we want you to see these patients; these patients can’t afford to see you right now, they need to see you. So the State is going to fund their care. And for those extra visits, we are going to provide very significant additional resources to you and into general practice.”

During his presentation to the national GP meeting earlier at the AGM, Dr Crowley said the IMO had concerns regarding “the policy-making rationale” of the eligibility expansion and the “accuracy” of the Government’s projections.

Dr Crowley also labelled Sláintecare “an aspiration without a plan”. He said the Government was putting forward a “mixed policy” with regard to eligibility expansion, which was taking place on an income basis and an age basis, with extension to children aged six and seven also set to occur.

Children under the age of six are already entitled to free GP appointments.

“There is no clarity on the numbers and assumptions are being used,” according to Dr Crowley. “The number could be anywhere between the Government estimate of 430,000 (including those aged six and seven) and 800,000.”

Speaking to MI after the meeting, IMO GP committee member Dr Aideen Brides, who is based in Monaghan, said GPs wanted to provide free care “but we are not ready to do that yet”.

“There needs to be a proper plan in place before you tell half a million people they are going to get free access to a GP,” she said.

IMO Director of Industrial Relations, General Practice, Mr Val Moran, told MI it was important GPs have a degree of choice concerning the new arrangements.

“That they are able to manage their own lists as they see fit and in a way that is safe for patients,” Mr Moran said.

“All agreements that we have reached and all measures that have come in through the State, whether it is chronic disease management, the contraceptive service, the under-sixes, it has always been up to individual GPs to sign-up to that measure. And we would hope that this will be no different.”

Mr Moran said “additional capacity measures” would also be required.

In addition to concerns about the eligibility expansion, the GP meeting also discussed pressures on out-of-hours services and the need for greater support for rural practices, among other issues.

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