The Health Section of the Draft Programme for Government contains a commitment towards the ongoing negotiation of a new GP Contract, as already agreed with the IMO. It also includes a commitment towards the delivery of Chronic Care in General Practice which has been agreed as the next phase of contract talks. 

We cautiously welcome a number of the initiatives outlined in the Draft Programme we note that many of these issues are already contained in the Memorandum of Understanding on a new GP Contract. The development of this contract is a priority for the IMO.

It is a matter of concern that the document is extremely light on detail, aspirational in nature and contains little in the way of cost projections. There is no indication of funding levels or indeed timeframe associated with the initiatives. The IMO are calling on the Government to back these aspirations with a commitment to invest in and resource General Practice. 

The IMO National GP Committee remain committed to negotiations for a new GP Contract.  This is the key priority in terms of delivering a modern, well resourced GP service to our patients. We expect that, if Government are truly serious about the development of our health services, they will show equal commitment and provide adequate resources.

Some of the key issues outlined in the Government document are:

New GP Contract – Expansion of GP Care to Under 18s

The IMO position is clear in this regard.  The Government document confirms that negotiations are underway on the new GP Contract and the IMO are committed to continuing in this process. The policy of the Organisation remains that there can be no expansion of patient groups (including Under 18s) until the new Contract has been agreed. Furthermore any extension of GP care should be on the basis of means and medical need.

Chronic Care

The IMO lobbied extensively on the positive impact for patients and value for the State in terms of the resourcing of Chronic Care in General Practice.  While the document does commit to a number of chronic disease areas it is aspirational and will require detailed negotiations to deliver in General Practice in terms of developing capacity, infrastructure and IT support.

Primary Care Centres 

We note a funding commitment to the development of 80 additional primary care centres in this draft Programme. As important is that priority be given to staffing of such centres. There must be a full team of allied health professionals in order to allow the GP to best treat their patients. 

Tax Incentives for Primary Care Centres

Tax incentives to support investments by GPs, dentists and other professionals in primary care centres, technology and service developments are noted in the document. These are to be welcomed but only if there are strict criteria to ensure that this is not simply another scheme for developers or a route to corporatise General Practice.  The IMO made detailed submissions to the Indecon Group who prepared a report for the previous government in this regard. The final report took on a number of our recommendations including that tax incentives be given to the individual GP for investment in primary care centres. We would sound a note of caution with regard to the phrase “other professionals” used the document. The IMO position is that primary care centres should be developed in conjunction with GPs and should not be used as an investment vehicle for corporate interests.

GPs working in Urban Deprived Areas

As you are aware the IMO have consistently sought recognition not just for rural GPs but for their colleagues working in urban deprived areas and we are pleased to see that GPs working in areas of urban deprivation have been recognised as being in need of specific supports. Again this was an issue outlined in the Memorandum of Understanding between the HSE, Department of Health and IMO in February 2016 and is part of the new contract discussions. We welcome the commitment in this regard but the devil is very much in the detail. A significant budget must be attached to this measure in order to fulfil the aspiration set out in the programme for government.

GP Access to Diagnostics

We welcome the commitment to provide GPs access to X-Rays, ultrasounds and other investigations. Again, however, there is no funding commitment nor detail as to how this will be achieved. As an item for discussion under the Memorandum of Understanding the IMO will be seeking to ensure that GP access to diagnostics will be achieved in a timely manner. 

Increase in number of GP Training Places

We welcome the announcement of a further 100 GP training places by 2021 however there is little point in training more GPs for export.  The training of new GPs will make little difference to the manpower problem until such a time as a new contract can deliver in terms of resources and capacity.  We would also encourage the development of capacity in general practice through giving supports to GPs to take on additional medical, nursing and support staff.

Expansion of Community Pharmacists Role

The expansion of community pharmacists role is something which must be monitored. The IMO view is very much that the separation between prescriber and dispenser should be maintained in the interests of patient safety and the clearly defined roles of pharmacist and GP should not in any way be blurred. Any encroachment on these clearly defined boundaries are not good for the patient.

Salaried GPs

There is provision within the Government document for GPs to be employed by the HSE on a salaried basis where needed and that the HSE would put in adequate support structures and staff for such GPs. While such an initiative may be useful in certain targeted areas we would be opposed to this being used as any kind of solution to a manpower problem. The real problem lies in the fact that General Practice is not viable under the current contract.