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By Mindo - 03rd Apr 2018

<h3>NAGP Extraordinary General Meeting set for September <strong> </strong></h3>

The NAGP is to hold an Extraordinary General Meeting (EGM) in September to discuss its end-of-year accounts, the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>) understands.

The move comes after the NAGP presented unaudited accounts to delegates at its recent AGM for nine months up to the end of December 2017. The NAGP’s financial year ends on March 31, 2018.

Commenting on the accounts, NAGP CEO Mr Chris Goodey described 2017 as a “very challenging year”. Fully-audited 12-month accounts will be available by 15 May, Mr Goodey added.

Fifteen-month accounts up to the end of March 2017 show the organisation recorded a deficit of €61,900, but the nine-month accounts record a surplus of €3,750, Mr Goodey outlined.

“That is because we cut a number of costs. We closed a local office, we consolidated on foot of our staff in Kilkenny and I took a pay cut of €24,000. A whole range of things took place in order to continue to make us viable,” Mr Goodey stated.

The nine-month accounts show outstanding membership fees of €134,000 and wages totalling €151,000. A general bad debt provision of €35,000 is included in the accounts.

Speaking to reporters, Mr Goodey said the amount owed in membership fees last December had “reduced”.

Commenting on payments made by MSC Eurocare for travel and accommodation for NAGP members who travelled abroad to inspect hospitals under the NAGP’s European Cross-Border Healthcare Directive awareness campaign, Mr Goodey said the Association “couldn’t ask GPs to pay for themselves to go over, and secondly, I wasn’t going to use NAGP funding to do that”.

In an earlier address to delegates, outgoing NAGP President Dr Emmet Kerin confirmed there was payment for travel and accommodation but “no fee or money was taken in terms of gratuity or anything like that”. 

Overall attendance at the AGM was low, with the Association pointing out that it had been rescheduled due to the recent adverse weather events.     


<h3>Sláintecare appointment due ‘in coming weeks’</h3>

Minister of State for Mental Health and Older People Jim Daly has said a recommendation will be made to the Department of Health in the coming weeks regarding the appointment of an Executive Director to lead the Sláintecare Programme Office.

In a speech to delegates at the NAGP AGM in Cork, Minister Daly said work on an implementation plan for Sláintecare is at an advanced stage within the Department and that Minister for Health Simon Harris hopes to bring proposals to Government shortly.

“The Government has already given its approval to move ahead with the establishment of a Sláintecare Programme Office within the Department of Health.  This office will be tasked with implementing a programme of reform, as agreed by Government, arising from the <em>Sláintecare Report</em>,” Minister Daly remarked.

“The recruitment process for an Executive Director to lead the Sláintecare Programme Office is advancing. It is expected that a recommendation will be made to the Department of Health in the coming weeks in respect of an individual for appointment.”

Minister Daly said that with commitment on “all sides”, he believed agreement was possible in the coming months “on a package that will see service improvements across general practice”.

He added: “The Government is committed to providing greater supports and infrastructure in the community, including better access to community-based diagnostic services, community care beds and to expand nursing services in the community.”

A panel discussion on the status of Sláintecare, which took place prior to the Minister’s speech, heard criticism of the lack of further developments on the plan, while GPs highlighted their frustration at insufficient progress in achieving a new GP contract.

Fine Gael Senator Colm Burke, a panel member at the discussion, expressed his frustrations and recounted numerous calls made by him for a new GP contract.

Meanwhile, NAGP CEO Mr Chris Goodey advised members that the Association may have to “up the ante a little bit” this year in order to achieve change.

He accused health officials of purposefully putting the NAGP “into a permanent roundabout” in terms of contract talks because there was not any money available to deliver the contract changes required. 

“I have it on good authority there is no intention for change in 2018, so maybe this is the year we really need to up the ante, but at what cost?” Mr Goodey stated. 


<h3>Call for national Suicide Crisis Assessment Nurse service</h3>

The NAGP has passed a motion calling on Minister for Health Simon Harris to immediately introduce a Suicide Crisis Assessment Nurse service for adults and children nationally.

Dr Catherine O’Donohoe proposed a motion at the Association’s AGM in Cork that it call on the Minister to immediately introduce such a service nationwide.

“No child should have to wait for a CAMHS [Child and Adolescent Mental Health Services appointment] if having thoughts of self-harm,” the motion read.

Dr O’Donohoe said she proposed the motion as CAMHS waiting lists are “out the window”. She said that children having thoughts of self-harm should not have to wait for lengthy periods to access care.

A Suicide Crisis Assessment Nurse service is in place in Wexford, Dr O’Donohoe said, but she understands that this is not the case in all locations nationally.

Separately, the meeting urged the Minister to make the CPD requirement for semi-retired or retired GPs more realistic by eliminating the audit component.

Proposing the motion, Dr O’Donohoe said that one of the reasons why more retiring GPs are not attracted to doing sessional work is because of the CPD requirements.

Arising out of this motion, another was proposed and passed. It stated that the NAGP urge the Minister to make the CPD requirement for all GPs more realistic by reducing the annual audit component to a five-yearly audit, similar to the UK.

The members also voiced support for another motion calling on Minister Harris “to immediately create five permanent seats for general practitioners, proportionate to our numbers, on the Medical Council”.

Meanwhile, NAGP members rejected comments made to the conference by Minister of State for Mental Health and Older People Jim Daly, who said the reversal of FEMPI would be in return for “service improvements”.

Cobh GP Dr Paul McDonald described Minister Daly’s comments as “unacceptable”.

“We are overworked… I don’t see where there can be more productivity. They need to reverse FEMPI cuts because without the reversal, we’re not going to attract young doctors into practice.”


<h3>New President wants IMO and NAGP to work together</h3>

The new NAGP President has said he wants the IMO and NAGP to work together to achieve a new GP contract.

GP trainee Dr Maitiu O’Tuathail said he believes there is goodwill on the part of both the NAGP and IMO to work together.

An NAGP ballot of members conducted in advance of its AGM in Cork showed that 84 per cent of members (1,152 responses) would not sign a new GP contract that had not been equally negotiated by the NAGP.

The Association said GPs are becoming increasingly vexed at the lack of action in terms of negotiating a new contract.

Dr O’Tuathail said the NAGP hopes to hold further contract talks with Government and HSE officials in the second week of April.

However, he argued that talks on the reversal of FEMPI needed to take place before discussion on a new contract.

“I think it’s disingenuous to start talking about the new contract without talking about the ‘elephant in the room’, which is FEMPI,” Dr O’Tuathail said.

Referring to the Framework Agreement between the IMO and Department of Health, to which the NAGP is not a party but has been accorded consultative status in negotiations, Dr O’Tuathail said he believes the agreement has been used as an excuse to delay progress.

“What we’re always hearing is, no progress is being made because both unions aren’t working together. I think it’s been used for years as an excuse as to why we haven’t made any progress.

“I don’t believe there’s any reason why both of us [IMO and NAGP] can’t be in the room together. I think there is goodwill on our side and I believe there is goodwill on the IMO’s side as well. I believe it’s in the Minister’s gift to allow us both to be in the same room at the same time.”

Cobh GP Dr Paul McDonald told the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>) he would like to see the Department negotiate properly with both the IMO and NAGP.

“This is too big and too important to be playing games in politics. They’re playing one off against the other… I’m with both the NAGP and IMO; I want the IMO to go in there with the NAGP and negotiate.”

<h3>Incoming President ‘has confidence’ in NAGP</h3>

Newly-elected NAGP President Dr Maitiu O’Tuathail has said he has “no concerns at all” in relation to issues raised by a number of members and Council members regarding the NAGP.

Dublin GP trainee Dr O’Tuathail said he is “absolutely” satisfied that all concerns raised have been addressed sufficiently.

“If I had concerns, I wouldn’t have put myself forward for President,” Dr O’Tuathail told the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>).

“I have confidence in both the Council and the board. We have had three or four very productive meetings and I have had no concerns at all. If I had concerns about the Council, board or CEO, I wouldn’t be here today. I’ve no concerns at all.”

The NAGP has lost six Council members in recent months, including former Vice President Dr Yvonne Williams. She was among a number of members to have raised concerns about a range of issues within the Association. Dr O’Tuathail said the majority of departing Council members were “retiring” or “just too busy”.

“The vast majority of them are either retiring because they are actually retired from general practice, or they’re just too busy. It’s really unfortunate&hellip; it’s a reflection of how general practice has become, that people are too busy to commit,” Dr O’Tuathail noted.

“I’d have no concerns. I wish them all the best. I know them all. They’re all leaving for their own personal reasons. If anything, it is good for any organisation to have new blood and change… They are being replaced by four trainees and I think we’ll have a bright future and I look forward to that.

“We’re bringing on four trainees, which is something we’ve never done before. The future of general practice, whether general practice lives or dies, is based on the actions that my generation take, so it’s time that my generation got involved. I think we’re very lucky to have four trainees get involved because ultimately, it’s our opinions and what we’re looking for that will shape the future of general practice.”

He said it was “a really exciting time” to be an NAGP member, as many more younger and dynamic people were becoming involved. “I think the Council will be reinvigorated after today.”

<h3>NAGP and UK FDA announce partnership</h3>

NAGP members have voted to establish a reciprocal membership agreement between the NAGP and the UK-based Family Doctors Association (FDA).

The majority of members at the Association’s recent AGM in Cork supported the partnership, which will see membership grow to 3,500.

Speaking to delegates, NAGP CEO Mr Chris Goodey said NAGP membership had already grown to 2,070, but there was a chance to grow the membership even further by joining the FDA.

Mr Goodey explained that it would mean “all members of the Family Doctors Association… will become automatic members of the National Association of GPs and vice-versa, the members of the National Association of GPs will automatically become members of the Family Doctors Association.”

Mr Goodey described the FDA as a “significant body who are on pretty much every NHS council”.

NAGP Honorary Member and Chairman of the FDA, GP Dr Peter Swinyard, also addressed delegates on the motion and explained that the FDA is an educational charity that splits its time between educational and political work.

The FDA holds numerous medical meetings in England, including small clinical meetings and larger events, Dr Swinyard said.

“If you choose, as an organisation, to join us and have a mutually beneficial exchange of membership, then you would as members be entitled to come and join any of those clinical meetings that you found helpful.”

He added that the FDA originated as an association of single-handed practitioners and then became an association representing small practices.

Dr Swinyard said he believed the relationship between the FDA and NAGP had already been a very valuable one. He said he had been privileged to visit Ireland twice, while Mr Goodey and NAGP members have also travelled to England to meet with the FDA.


<h3>GPs can name Irish hospital and consultant in CBD referrals</h3>

GPs are not required to provide the name of a hospital and consultant abroad in order to generate a referral under the EU Cross-Border Healthcare Directive (CBD), it has emerged.

Ms Catherine Donohoe, HSE General Manager, Commercial Unit, Acute Hospitals Division, told the NAGP AGM that GPs can give the patient a referral to a named hospital and consultant abroad, or to a named hospital and consultant in Ireland that can then be used by the patient to access care abroad.

The specific provision, developed in response to concerns by GP insurers, is not widely known among GPs making referrals under the scheme.

“Where a GP is not comfortable referring a patient to a hospital abroad and a consultant abroad that they don’t know, they make the referral to a named hospital and consultant in Ireland and then the patient can opt to use that referral to access healthcare abroad,” Ms Donohoe advised.

“That removes the clinical responsibility for the decision to go abroad, to a consultant that you don’t know, from you onto the patient. The patient then organises their own appointment abroad in whatever centre they are choosing to access it.

“When I was setting this up, I had a lot of interaction with the ICGP and of the three insurers of GPs, two of them said they would not insure their GPs to refer patients directly abroad to a consultant and a hospital that the GP was not familiar with. So what we agreed with the ICGP is that the GP can refer the patient to the local hospital and it’s up to the patient then if he or she wants to use that to go elsewhere.”

Ms Donohoe noted that all referrals must be to a named hospital and a named consultant and that referrals must pre-date the patient accessing the care.

In 2017, the HSE received 4,800 queries regarding the CBD and over 2,000 reimbursements were issued by the HSE.

The most common treatments accessed relate to orthopaedics, ENT and ophthalmology. 

On the fact that uptake is low — although it is increasing — Ms Donohoe explained that the public and GPs simply think the Directive is “too good to be true”.

Cultural barriers and lack of information about which hospitals to access care are others reasons contributing to low uptake.


<h3>HSE urged to provide GDPR grant</h3>

A GP has suggested that the HSE provide a grant to general practices to assist with implementation of the General Data Protection Regulation (GDPR) within their businesses.

The GP in attendance at the NAGP AGM, who did not wish to be named, said it would be helpful if the HSE considered a limited GDPR grant to help practices cope with the changes in the context of FEMPI and the loss of resources.

“They’ve done this before… when the vaccination programme was being revamped, back 10-to-15 years ago, they provided us with an incentive to get all the necessary equipment and you were reimbursed,” the GP told the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>).

“We will probably have to revamp our systems because you can’t use your Internet on the network your practice system is on, so you’re probably going to have to set up a parallel network. You can’t work without the Internet these days, so there will be extra cost involved.”

The GP also urged the Data Protection Commissioner to accept the recommendations of a document on GDPR submitted by the ICGP.

“It’s vital because they have tried to lay out a roadmap of how this can be implemented in general practice and I think if that’s accepted, then this will work for us… The ICGP have laid out a template; you basically have to put together a folder and demonstrate that you’ve done your training and you’ve looked at your IT system, security and it’s all reasonable. If we have our professional organisations negotiate on this, I think it will work out.”

The GP made the comments following a workshop at the NAGP AGM on new data protection regulations. The workshop was delivered by Mr Stewart Thompson, Director, Global Privacy and GDPR Technology at IAC Applications.

All organisations have until 25 May to comply with new laws on data protection, or potentially face fines of up to 4 per cent of annual turnover, or €20 million (whichever is greater). The NAGP has previously appealed for GPs to be included with other public bodies for fine exemptions.

The HSE has said it is the data controller in respect of medical card patients, heard the meeting. 

Mr Thompson described this as “good”, as it means the GP is then a processor of information, which imposes fewer obligations on GPs than if they were data controller. 

<h3>Warning on valproate medicines in women of child-bearing age</h3>

A GP and pharmacist has advised all GPs to ensure that no female patients of child-bearing age are taking Epilim (sodium valproate).

Cork GP Dr Paul Ryan gave a detailed presentation at the NAGP AGM on important factors to consider in medication safety.

Looking specifically at sodium valproate, Dr Ryan stated that the drug is used to treat epilepsy, bipolar disorder and migraine.

It has been known for many years that the drug can cause birth defects. However, a recent review by the European Medicines Agency (EMA) has highlighted the high level of harm that can be caused if the drug is taken during pregnancy.

Dr Ryan advised GPs to conduct an audit of patients on sodium valproate and to generate a list of patients of child-bearing age on the drug for review, counselling and assessment.

“The bottom line ‘take-home message’ is you [must] know the patients in your practice that are on sodium valproate. Make sure no woman of child-bearing age is on it,” Dr Ryan said.

In February, the HSE wrote to GPs, advising them of increased restrictions on valproate medicines, including a pregnancy prevention programme.

It asked GPs to devise a list of patients of child-bearing age who are taking the medicine and to make contact with these patients for review.

Meanwhile, Dr Ryan outlined that medication errors cover 20 per cent of litigation in general practice.

He detailed important and potentially dangerous drug interactions for GPs to be mindful of, including azathioprine and allopurinol, and fusidic acids and statins, among others.

Commenting on the contraceptive pill Dianette, he recommended GPs avoid prescribing the medicine as a contraceptive and that it should be prescribed for six months only in respect of treatment of acne.

Meanwhile, he described Canespro, which is used to treat fungal nail infections, as “unbelievable”.

Used daily on affected nails, it has an 82 per cent chance of eliminating the infection after six weeks.

The result is much more favourable than those generated by other treatments for fungal nail infections, including oral tablets, Dr Ryan advised.

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