CHOs are the new HSE Structures for community care and specifically affect GPs in the following areas: 

• Creation of a new GP Lead post in each of the CHO areas who will be a member of the CHO Executive Management Team and will be in an employed position
• Creation of a GP Lead post in each of the 96 GP Network Areas which is envisaged to be a protected time position.
• GPs moving to work within GP Networks

While CHOs have the potential to provide better community based services to patients to date there is little evidence that the resources are being provided to put in place what is actually needed. Prior to any rollout of any new services, work practices or pathways there are some necessary steps to be taken. These are: 

1. Conclusion of negotiations on a new GP Contract;
2. Agreement on the roles and terms and conditions for the GP leads;
3. A plan for the implementation and rollout of any new protocols, services and pathways.

Agreement must be reached on the introduction of new resourcing to General Practice to allow for: 

• operation of any proposed integrated care pathways;
• direct resourcing to General Practices to allow the funding of any new work and to attract & retain new entrants to General Practice;
• capital development funding within existing practices to allow for enhancement of service provision;
• access as specialist practitioners to appropriate imaging and diagnostic pathways.

So while in principle the IMO supports the concept of CHOs, in practical terms this is a key issue for a new GP Contract. To implement new structures in advance of negotiations on a new GP Contract is putting the cart before the horse.

As an Organisation we have concerns that new work practices and associated protocols will be put in place without negotiations and provision of adequate resources. It would be assumed that these practices and protocols could become accepted part of GP work.

Current HSE and Department of Health policy is to refuse resourcing for workload which the HSE considers GPs have historically performed as part of their “normal course of practice.” This follows from an ESRI advisory report to the government submitted prior to the under 6's negotiations. 

This report states that no additional fees should be negotiated for what is already considered to be part of “the normal course of practice by a qualified GP in treating a patient”. The report further advised Government to consider the evidence as to whether the service is already being provided under the capitation system and if not why not.   

The ESRI were of the view that additional services, not currently provided for under the contract, could be delivered through improved protocols, practice notes or through changes to GP education and training, as alternatives to a new fee for additional services.

The IMO rejected this position.

GPs have been to the fore in adapting their practices so as to deliver better services to patients but unfortunately that has come at a price. With the cutbacks imposed under FEMPI and increasing pressures to deliver services General Practice cannot keep on absorbing more and more work without resources.

The IMO position on CHOs has been consistent – they are a good idea but must be resourced and such resourcing must be negotiated in the context of negotiations on salaried positions within the Workplace Relations Commission and negotiations on GP involvement in networks in the context of a new contract.  The implementation of CHOs is a specifically defined issue for negotiation in the Memorandum of Understanding between the Department/HSE and IMO.

The IMO have already advised the HSE of our concerns and encourages members who share those concerns to attend the consultation meetings and ensure the HSE are aware of the issues from an individual GP perspective.