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Rural, Island, and Dispensing Doctors

Harris ‘won’t referee’ between IMO and NAGP

Minister for Health Simon Harris is “not going to act as a referee” between the IMO and NAGP in GP contract negotiations, according to Independent TD Dr Michael Harty.

Speaking to the Medical Independent (MI) at the 31st Annual Conference of Rural, Island and Dispensing Doctors, Dr Harty said: “The Minister for Health is very serious about initiating negotiations on a new contract; he wants to do it. But he does see a difficulty if there are two unions which are not united, because he is not going to act as a referee between one union against another. He is not interested in that; he is not interested in having one union in one room and another union in another room and the two of them not talking and the Department of Health and the HSE moving around in rotation.

“If they come in on a disunited front, the end result — the contract — that will come out of that will be less than desirable. So they have to have a united front. He understands the differences there are between the unions and he wants that sorted. I would think he wants that sorted before negotiations start. So if they are going to be at each other’s throats, that is going to hold up negotiations, and if negotiations go forward, it is going to lead to a less than satisfactory outcome.”

Dr Harty, who is a member of both the IMO and NAGP, said there is a “huge crossover in membership”.

Tensions have simmered between the organisations in recent months and there were strong words exchanged between some members of both organisations during the Conference. Some GPs expressed concern that the State will play the two bodies against each other.

Co Mayo GP and former IMO President Dr Ken Egan said the organisations are “two separate businesses”. He added: “One wants to beat the other and that is what will happen, it is all about membership… We have to accept it is two businesses out there.”

In his presentation, Dr Padraig McGarry, Chairman of the IMO GP Committee, acknowledged the input of the NAGP in the No Doctor No Village campaign. However, he also criticised the Association for publicly welcoming a proposed deal on rural practice supports when, he claimed, the IMO was seeking to strengthen its terms. He also referred to a profound lack of trust.

Dr McGarry told MI the IMO had not been issued any official update on contract talks, to include a recommencement time-frame and the invitation of the NAGP to the negotiations.

He said the IMO had received a clear mandate from its members to represent them and that the NAGP is “another negotiating body”.

NAGP CEO Mr Chris Goodey said his Association would have “no problem” being in the same room as the IMO. MI recently revealed that the NAGP had written to the IMO seeking to meet before the recommencement of formal contract talks in an effort to find common ground. 

Work practice changes are among key reforms – Harty

Altering doctor work practices is among the key reforms required in the health service, independent TD Dr Michael Harty told the 31st Annual Conference of Rural, Island and Dispensing Doctors in Clifden, Co Galway.

“We do need to alter work practices. GPs need to alter work practices; hospitals need to alter work practices,” he said.

Dr Harty said many work practices in hospitals are “difficult to understand”. He referred to a lack of senior decision-makers “on the floor seven days a week”. He said some consultants were very powerful in their hospitals, having “built up little empires”, thereby making change difficult.

Speaking to the Medical Independent (MI), Dr Harty acknowledged that changing work practices in hospitals would demand extra consultants. “There isn’t a consultant in the country who would say there are enough consultants. But you need to have the consultants in the right place at the right time, so yes, you need to have more consultants.”

He emphasised the importance of having local, integrated community care teams where everyone is equal. “You have to have a totally new approach where the hospital isn’t dominant and the GP or general practice isn’t subservient; they should both be equal.”

In his Conference speech, Dr Harty referred to the need for better recruitment and retention, increased bed capacity, seven-day access to diagnostics and integration between hospitals and primary care services. He said these concepts were also accepted by the Oireachtas Committee on the Future of Healthcare, of which he is a member.

He recalled the difficult situation facing rural general practice as having prompted his decision to run for a Dáil seat earlier this year.

“We as GPs, certainly in my area, were really devastated by the cuts that were inflicted on general practice over the past five years… Our FEMPI cuts were very severe and very deep. There was great dissatisfaction with the way the under-sixes contract was introduced last summer and I think that was the impetus that got me going and got the No Doctor No Village campaign going. The manner in which it was introduced was, I think, to the dissatisfaction of most GPs.”

Dr Harty said there is a “mood for change in this Government” and that Minister for Health Simon Harris is “willing to listen to new ideas”.

In response to a question from the floor by Co Mayo GP Dr Ken Egan, on whether general practice could expect extra money in the October budget, Dr Harty said he doubted it.

“I think the contract that is going to be negotiated now over the next year or two is where money in your pocket is going to come. It is going to depend on the negotiation of a new contract.”

IMO GP Committee Chair Dr Padraig McGarry also warned him that “the tradition of the HSE is for workload to go one way, from secondary care to primary care, unresourced. That is the way it happens all the time and unfortunately, that appears to be the way it is going now with the CHOs and local integration teams.”

Dr Harty said integration “just won’t happen unless you resource primary care”.

Island health review nearing completion – Minister

A final report on island primary care services is expected to be completed this month, the Minister of State for Health Promotion told the 31st Annual Conference of Rural, Island and Dispensing Doctors in Clifden, Co Galway. 

“Rural Ireland, our islands and the people who live here are important parts of Irish culture, particularly here in the west of Ireland,” said Minister Marcella Corcoran Kennedy. “In the context of valuing the cultural contribution of our island population and working to promote the positive aspects of island life, the HSE’s Primary Care Division has undertaken a national review of island primary care services, which began in June 2015.” 

Minister Corcoran Kennedy said the review process is guided by a steering group that includes representatives from Comhdháil Oileán na hÉireann as well as two practising GPs who provide services on islands.

“Health profiles are being compiled for each island based on census information, existing community resources and consultation with island communities, which have taken place through community meetings on each island.

“A final report is expected by the end of October this year, which will make recommendations on how high quality, accessible, safe services should be provided to our islands in a more integrated, sustainable and cost effective manner. I look forward to seeing the positive implications of this review for both GPs and patients living on these islands.”

GPs in rural locations have a “particularly challenging role”, she acknowledged. The geography and population spread in some of the country’s more isolated areas “present significant obstacles to patients accessing their GP, particularly for the elderly or socially disadvantaged. 

“GPs in such areas, many of whom are single-handed practitioners, face severe pressures to meet the needs of these patients and as a result their out-of-hours and on-call commitment can be particularly burdensome.”

She said enhancing primary care and integrating primary and secondary care services are priorities for this Government. “I am convinced that GPs are capable of taking on a leadership role in the development of an integrated, team-based primary care system.”

The potential benefits of an enhanced, integrated primary health care sector “must be realised and supported by a new contract for general practice”, outlined the Minister.

No Doctor No Village campaign ‘belongs to all’

The No Doctor No Village Campaign “doesn’t belong to any organisation”, one of its co-founders told the 31st Annual Conference of Rural, Island and Dispensing Doctors in Clifden, Co Galway, last weekend.

Co Clare GP Dr Liam Glynn said there are GPs from the IMO and the NAGP involved in the ongoing campaign, which he described as “a pressure group of some sort”.

“And what I am hoping is that as we go on, it can continue to be that, and if anything, can contribute to helping our negotiating organisations to do the very difficult job they need to do,” said Dr Glynn, who is Chair of Communications with the NAGP.

“With that in mind, I really want to pay tribute to the huge, hard work of the IMO, with regard to the RPA [rural practice allowance] and what has happened in the last year. I know a lot of the guys involved in the negotiation. Michael Kelleher, who is a west Clare GP like myself, was incredibly supportive to everything we did and yet was trying to do all this work as well… The lesson for me is when we sit down together and when we work together, the ICGP, the IMO, the NAGP — it is incredible what we can achieve.”

Dr Glynn said that, one year on, “maybe on the face of it, there has been very little actual change but I do get this sense of the ‘stars aligning’”.

He recalled his own “bruising battle with the HSE around the removal of my rural practice allowance” and the support from the NAGP, as well as GPs “of whatever hue” around the country. His own experiences and the despair felt by rural GPs prompted him to become an activist, he outlined.

“Pierce Molony made a really important point earlier on, and that point is about garnering the support of the people we look after, because whether you realise it or not, you are hugely valued in the communities you work in. Our first meeting, when we dipped our toe in this water in Corofin, it was standing-room only… It was at that meeting that those Government TDs, certainly it was the first time I heard them, acknowledge that they had to do something for rural practice and that they were in support of an expanded RPA.”

Dr Glynn thanked conference founder Dr Jerry Cowley and Dr Michael Harty TD for making “the boldest step” by putting their names forward for General Election 2016.

“I really want to acknowledge the two of them because without them, I think the steps we’ve made since then would have been extremely difficult.”

He said social media was also a key tool in communicating the situation of rural GPs to patients and the wider public.

Dr Glynn said the Rural Practice Framework has improved the situation of certain GPs, but there is significant room for improvement.

He said the NAGP is working on 10 cases where GPs are trying to achieve the RPA.

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