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Looking forward, looking back

Annual conferences are often a time for reflecting upon the previous year and strategising for the forthcoming 12 months. For members of the IMO leadership, it was also a time for contemplation, as some step down from their roles or move to new positions.

We sent a series of questions to members of the IMO Council at this time of flux and we got some revealing answers back.

Prof Trevor Duffy tells the Medical Independent (MI) the final days of his time as IMO President provided him with an opportunity to look back on a hectic year and to assess the immediate future of the body.

“As I come to the end of my term as IMO President, I have been reflecting on the events of the past year but more importantly, as an Organisation, we are focused on the years ahead,” says Prof Duffy.

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Dr Trevor Duffy

“Being President of the IMO is a tough and demanding role but I have enjoyed every minute of it and the experience has given me an even greater insight into the importance of unity and solidarity amongst the profession. With that unity, we can achieve much,” he tells MI.

“I am even more convinced than ever that it is only through an Organisation that represents all doctors that we can achieve real change and not allow ourselves to be exploited by those who would seek to appease sectional interests to the detriment of the profession.

“It has been an honour to serve as IMO President and I wish our incoming President, Dr Ray Walley, great success in the year ahead.”

Unity

Looking at the year ahead, the new President is convinced it is the “unity” of the IMO that is its greatest strength. Without mentioning any of its organisational rivals — such as the IHCA or the ‘new kid on the block’, the NAGP, Dr Walley’s emphasis on ‘unity’ also points to the IMO’s commitment to speak for doctors as a whole.

“I strongly believe that the medical profession is best served when we stand together, united,” Dr Walley tells MI.

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Dr Ray Walley

“The public health services are complex and many of the negotiations and discussions going on for our colleagues in the hospital and community may have an impact on general practice so we must, through the IMO, have our voice heard.

“The unity of the membership, across the specialty groups, is one of the key strengths of the Organisation. We have autonomy within our specialty groups but have the benefit of solidarity and the support of the whole profession, which is critical in the areas of health service development and policy.”

Much to grapple with

As the former head of the GP Committee dealing with GMS contract disputes, resource problems, free GP care for under-sixes and the rise of the NAGP, Dr Walley has had much to grapple with — a good training ground for his new term in the top seat, perhaps?

“When I took on the role of GP Chair at the 2012 AGM, I committed to defending the rights of my GP colleagues in terms of representation and to take on the fight against the savage cuts to the resources of general practice,” says Dr Walley, who spoke to MI prior to the recent agreement between the IMO, the Department and the HSE.

Health policy is a matter for Government but in recent years, the health policy appears to be driven more by political expedience

“This has been my core objective over my three-year tenure as GP Chair.”

New President Dr Walley has concerns that with election season almost upon us, the debate over health policy could generate more heat than illumination.

“Health policy is a matter for Government but in recent years, the health policy appears to be driven more by political expedience rather than evidence-based medicine,” he says.

“As the general election approaches, no doubt all parties will make promises and create spin around the future of our services — I fear much of these promises will be based on what political focus groups are telling them, as opposed to listening to medics.

“The IMO wants health to be a serious issue for debate over the coming year, not a political football.

“Health is a serious business and we want it to be taken seriously.”

Advice

Also in health politics, Prof Duffy’s time in the hot-seat coincided with the appointment of a new Minister for Health. We asked him what piece of advice would he have for Minister Varadkar?

“If I had one piece of advice for any Minister for Health, it would be to listen to doctors; we are solution-driven, we want the best for our patients and we know what will work in practice — not in some theoretical model,” he replies.

But he is also convinced that the IMO has a unique role in influencing the health policy process.

“The IMO is a member-driven organisation and therefore is an authoritative voice on health policy,” he says.

“With that authority comes responsibility — the responsibility to advocate for change that is based on medical evidence and that will deliver real improvement for patients and doctors. As an Organisation, we continue to develop policy positions on topics that would otherwise be ignored.”

For the new President Dr Ray Walley, working on the front lines of GP negotiations in recent months has given him a unique perspective on Government policy interventions.

It is vitally important that NCHDs keep an energised, engaged and united front

Speaking after the announcement of the recent GP contract agreement, the new President was in upbeat mood. “We have stopped the cycle of cutbacks and begun the process of bringing new resources into general practice,” he said in a statement.

Committed

“We have more to achieve but we are committed to the development of a new GP contract that is capable of delivering 21st Century GP Care to patients.”

Dr Walley claimed that it was particularly significant that the IMO had secured the withdrawal of the draft contract issued by the HSE in January 2014, under which the HSE proposed to roll-out GP services for children under the age of six. “That contract was unworkable and was simply a Trojan horse to force new terms and conditions on GPs which would not have been viable or sustainable.”

Scarred landscape

It may not have been a year of NCHD industrial action, such as in 2013, however the outgoing President nonetheless says it was a period of intense activity. He feels that the Irish medical landscape is still scarred by the cutbacks in the health sector over recent years.

“Since our last AGM in April 2014 the Organisation has, on behalf of our members and the patients we serve, engaged in a huge range of activity across our industrial relations, policy and communications platforms,” says Prof Duffy.

I won’t repeat the litany of charges laid against colleagues, save to say that, in summary, we were too expensive and “needed taking down a peg or two”, or three, or four

“The past year has seen some major issues being addressed on the industrial relations front for almost all of our membership.

“Many of the problems in our health service are as a direct result of the savage cuts of recent years and the attitude of the HSE towards medical professionals.

“The net effects of this have been to reduce services to patients and to create a work environment that has driven doctors abroad.”

Winning the battle of spin in the media

Winning the media battle will be important for new President Dr Ray Walley during forthcoming negotiations with the Government.

However, this is something that Dr Walley has garnered much experience of in recent years in his role of leading the GPs in the IMO.

“We have run a focused campaign around #ResourceGP, which is aimed at making all stakeholders — patients, colleagues and politicians — aware of the true facts of general practice, the real nature of cuts and the impact on patients but more importantly, the potential of general practice to deliver more for patients if better resourced,” says Dr Walley.

“The response from our paymasters has been to spin against GPs and in the past year we have been blamed for everything from the medical card debacle to the ED crisis.

“We have been quick to respond and state the bald facts — the medical card debacle was as a direct result of Government policy to cull cards from older and vulnerable people and we were to the fore in highlighting this issue across all media platforms — the ED crisis is as a direct result of Government policy to reduce funding to the health services, leading to a reduction in acute beds and inadequate nursing home places — yet it was claimed GPs were responsible,” he comments.

“It’s truly farcical but the real irony is that GPs are part of the solution. With investment and ongoing resources, we have the potential to deliver so much more, particularly in the area of chronic disease management.”

CHOs set to create real change in healthcare

The establishment of the community healthcare organisations (CHOs) “may herald the most significant organisational restructuring of public health and community health medicine in many years.”

That is according to the Public Health and Community Health Committee of the IMO.

“As doctors, our focus will always be on our patients but the new CHOs do present some challenges to the existing public health and community health departments,” says the Committee in reply to MI questions.

“For instance, the CHOs established in the East/North East do not match the areas served by the existing departments of public health or community health. Currently, one public health department covers one-third of the Irish population in Dublin, Wicklow and Kildare. That population will now be served by three CHOs in the new structure. Decisions will have to be made going forward as to how best the population of those three CHOs can be provided with public health services, while avoiding unnecessary overlap and triplication of duties.

“Overall, the move to delivering community-based health services in the areas served by the CHOs necessitates changes in working practices in four of the eight departments of public health. Those changes cannot take place without discussion and agreement with the IMO.

“Regardless of the structures that are in operation, the greatest challenge facing the departments of public health remain our inadequate staffing levels, both in the medical and non-medical grades.”

Steadying the IMO ship after the strike storm

Following the NCHD strike of late 2013, the last year may have seemed a little sedate in contrast.

However the challenges with EWTD and the working lives of young doctors remain to the forefront of the IMO, leading members tell MI.

“We have also campaigned very strongly on the EWTD issue,” says Prof Trevor Duffy.

“It defies belief that even as our doctors are emigrating and being forced to take industrial action on illegal and unsafe hours, the HSE continue to persist in half-hearted attempts to resolve the EWTD problem and fails to meet the agreed targets.

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Dr John Duddy

“In our fight to allow our NCHDs the basic right of legal and safe working hours, we brought the campaign to the European Union.

“In recent weeks, the European Court of Justice has given its opinion that Ireland is in breach of the EWTD, so perhaps now we will see some real engagement and proactive attempts by the HSE to actually try to resolve the problem.”

NCHD Committee Chair Dr John Duddy tells MI that there have been some progressive steps made on the issue, however “full EWTD compliance is still far from the finishing line. Follow-up verification meetings have been held and some progress has been made.”

“In most cases, working hours have been reported based on payment which is accurate. However the recording of breaks and other rest periods is less robust, which will require greater scrutiny.

“The application of penalties has been inconsistent and is in need of greater focus to achieve better compliance.”

Outside the area of hours and pay, Dr Duddy thinks the new role of lead NCHDs could have significant impact on the working lives of young doctors.

“As the role was only rolled-out nationally in January 2015, it is difficult to assess its impact so far,” says Dr Duddy.

“However, it is an exciting prospect that will finally give NCHDs a voice at executive level in hospitals around the country.

“It should allow NCHDs to take on management roles at an earlier stage in their career and give them the skills to become the clinical directors of the future.”

Dr Duddy says the youthful energy that NCHDs bring to the IMO is an integral part of the Organisation’s strength.

“It has been an honour to represent my colleagues and friends over the past year as Chair on the IMO NCHD Committee,” says Dr Duddy.

“It is vitally important that NCHDs keep an energised, engaged and united front when tackling all the issues that face our speciality and I would urge everyone to get involved.”

Blame game: The continuing consultant conundrum

Consultants feel they have been unfairly blamed for many problems in the health system, but that situation is beginning to slowly change, one leading IMO consultant member tells MI.

“For the past several years, there has been a perception created that many, if not all, of the ills of the health service could be laid at the door of consultants,” says Dr Peadar Gilligan, Consultant Committee Chair.

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Dr Peadar Gilligan

“I won’t repeat the litany of charges laid against colleagues, save to say that, in summary, we were too expensive and needed ‘taking down a peg or two’, or three, or four.

“This past year has seen something of a change in that jaundiced judgement and there is now a creeping recognition that consultants are a part of the solution to the many ills of the health service.”

The background to the problems between the Government and consultants is well known. Prof Duffy calls the 30 per cent reduction in new consultant pay “one of the more foolhardy decisions by Government”.

If anything, Dr Gilligan is stronger in his criticism of the move.

“The unilateral, arbitrary and reckless pay cut imposed on newly-appointed consultants in September 2012 did exactly as the IMO predicted and made Ireland an unattractive place in which to practice medicine,” he says.

“Our medical professionals are voting with their boarding passes and leaving this country because flawed management policies have driven them to leave.”

But given this difficult situation, the outgoing President feels the IMO has done its best to improve the situation.

“The IMO, as the only body representing consultants on national pay issues, negotiated a new deal for our new-entrant consultants which, while far from perfect, is the first step towards restoring pay parity at consultant level. Restoring that parity remains our goal,” says Prof Duffy.

“The agreement recently concluded by the IMO and health service management offers a way to address at least some of the unintended consequences of the September 2012 pay cut,” adds Dr Gilligan.

“That unilateral cut of 30 per cent superimposed on pre-existing cuts had a huge and dramatic impact on the morale of doctors in training and consultants in Ireland.

“That someone should be expected to do the same onerous job for markedly different terms and conditions is unfair. I would contend that the 30 per cent cut must be fully reversed and newly-appointed, and trusted, colleagues treated on an equal basis with their peers.”

Dr Gilligan warns health management that there is still much work to be done to improve the retention and recruitment crisis among consultants.

“Nevertheless, despite serious misgivings, IMO members accepted an agreement — at the second time of asking, I hasten to add — that would undo a significant proportion of the damage done by the initial cut,” he says.

“I call on the HSE and others in health service management to fully honour our agreement and to move to fill existing vacancies as soon as possible.

“However, let there be no misunderstanding — as far as senior medical professionals are concerned, the Irish health service is facing a crisis of confidence and credibility. We are unable to fill NCHD posts and there are approximately 300 consultant positions without a permanent appointment; this is a shocking figure.

“There has been an unprecedented number of resignations from consultant posts in the last number of years and for a variety of reasons recruitment is likely to remain challenging and, as a result, hospital services will in some cases be curtailed, discontinued or fail to be established. Under-resourcing of the system and the daily pressures on those who provide care here have had a dreadful impact on the recruitment and retention of doctors.”

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