You may have recently received correspondence from the HSE with regard to National Clinical Care programmes such as the Respiratory Integrated Care service and in other cases palliative care programmes. Please note that this work has not been negotiated with the Irish Medical Organisation and is not encompassed by your GMS contract. As you are aware the IMO are in negotiations with the HSE and Department of Health with regard to a new contract which it is envisioned will encompass chronic disease management along with the necessary capacity and infrastructural requirements.

The current letters, an example of which can be seen here, are not part of this process and members are not contractually obliged to engage with same. It is the view of the IMO that it is only once there is a contractual under pinning with adequate resources that chronic disease management, and the associated workload, can be dealt with in General Practice. 

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 Practice 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.

While in principle the IMO supports the concept of Chronic Disease Management in General Practice, 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.

I would draw member’s attention to 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.

Additionally, as our members are aware the GMS contract covers “all proper and necessary treatment of a kind usually undertaken by a general practitioner.” Given the vagueness of this definition, one interpretation of the contract is that work assumed by GPs generally could be said to become incorporated into the GMS contract. It is of course a matter for all GP’s to decide individually whether they wish to engage with these programmes but as your representative body the IMO must advise you as to the extent of your contractual obligations and that the work referred to in the attached letters is not currently contracted or resourced and does not currently form part of the GMS Contract.

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.

It is of course a matter for all GPs to decide individually whether they wish to engage with these programmes but as your representative body the IMO is entitled to advise you that the work is not currently contracted or resourced.