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Varadkar proposes rural allowance ‘expansion’

Speaking yesterday at an IMO seminar in Dublin, he said the proposal would change the way the allowance works, “so that it applies to an area or a practice, rather than an individual GP”.

He said it would “apply to any population centre of less than 2,000 people within a three mile radius or 4.8 km”.

Outlining proposals pertinent to the new GMS contract negotiations, but which could be achieved in a speedier fashion, Minister Varadkar said it would be put to the IMO in a matter of days.

“The effect of that would be to increase the number of GPs who qualify for the rural practice allowance from about 160 to 250 or so. It is something that will obviously be put in front of you, for your opinions on, and for your discussion in the time to come.”

Latest HSE figures showed 15 GMS list vacancies (10 urban and five rural), he said.

Minister Varadkar said that, under the proposal, existing holders would retain the rural practice allowance and the change could be achieved “quickly” if agreement was reached.

Other areas that could potentially be progressed more quickly were new items of service and scrapping of distance codes

“We are also keen to make some progress on new items of service, particularly around enhanced STCs,” continued the Minister.

He said suturing is currently not economic for most GPs and an agreement could reduce ED attendances for minor injuries.

“Something similar is perhaps possible on 24-hour blood pressure monitoring and also on long acting reversible contraceptives (LARCs).”

While the Minister confirmed that reversing the scrapping of distance codes was also a matter he was willing to pursue, “we don’t have enough money in the budget this year to restore it immediately”.

He warned that negotiating a comprehensive contract “will take time and will have to be funded”.

In other comments, the Minister said that the Departments of Health and Finance had agreed to establish a working group “with a view to including something in the budget for 2017, to support GPs and others who want to invest and expand their existing premises”.

Minister Varadkar said he believed primary care centres were “a very good thing” but that not all GPs needed to be located in one.

He said primary care should be “GP-led” but that he hoped most GPs would accept a greater role for community pharmacists in respect of “managing minor ailments, administering more vaccines, and doing more medicine management and monitoring”.

He indicated that Fine Gael would commit to “ring-fenced” additional annual funding for primary care, but that a figure had not been agreed.

Meanwhile, the Minister said he was eager for the new contract to support a greater role for GPs in chronic care, which was the focus of the IMO seminar.

“As part of the contract, I’d like to see more GPs encouraged to provide expanded services like chronic disease management, minor procedures and first line investigations. I am keen, however, that GPs should not become de facto public servants, entirely dependent on the State for their income. The autonomy and business-orientated approach is one of the things, in my view, that makes general practice work.”

Minister Varadkar said some GPs in rural and urban deprived areas could be “salaried” but that GPs in general “should remain independent”.

Asked about the possibility of salaried GPs in some areas, IMO President Dr Ray Walley told the Medical Independent (MI) any such proposal would need to be outlined in detail.

“You have infrastructure costs, IT costs and other staff costs,” noted Dr Walley, who practices in an urban deprived area. “At the end of the day, it may be attractive to some people but they haven’t discussed it with us at the moment. It is possibly one option but I’m afraid it hasn’t been debated at the table.

“The devil in all of these things is in the detail…Ultimately other countries have got around this by having a deprivation weighting or rural weighting.”

Similarly, regarding Minister Varadkar’s comments on the rural practice allowance, Dr Walley said the Organisation would “like to see the detail”.

Yesterday’s IMO seminar heard that the percentage of the population aged over 65 was forecast to grow from 11 per cent in 2006 to 26 per cent in 2026, which would greatly increase demand for treatments for chronic ailments and illnesses.

Tramore GP Dr Austin Byrne warned that, over the coming years, the demand for acute hospital beds for patients over 65 alone will be greater than total acute and day-case beds currently in the entire hospital network.

“The total bed capacity increase required to maintain current service levels in our hospitals will be in excess of 50 per cent more beds in the system. Therefore we simply have to invest now to move chronic disease care out of the hospitals and into general practice.”

Dublin GP Dr William Behan calculated that for every €10 million invested in general practice there would be a corresponding freeing up of €50 million in hospital resources, so as to allow the acute system to deal with cases of greater acuity.

General practice in the UK receives 9.5 per cent of the total public health budget. In Ireland, he said, this figure is 3.2 per cent.

Dr Tadhg Crowley, a GP in Kilkenny, spoke on the experience of treating heart failure. Dr Crowley said that, in 2012, heart failure cost €660 million with 50 per cent of these costs relating to patients being hospitalised – accounting for seven per cent of all hospital beds used in that year in the system.

Dr Crowley suggested that an integrated structured programme through general practice could reduce outpatient attendances by 25 per cent and hospital admissions by 16 per cent.

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