Taoiseach Leo Varadkar TD and Minister for Health Simon Harris TD today welcomed the agreement with the Irish Medical Organisation (IMO) on a major package of GP contractual reforms which will benefit patients and make general practice a more attractive career option for doctors.
Taoiseach Leo Varadkar said: "I am very happy that we have been able to conclude an agreement with the IMO on a revised GP contract.
"The agreement provides for 40% increase in funding for General Practice over the next four years and it's frontloaded.
"I believe this will encourage more doctors to go into General Practice and will provide new funding to develop practices and the services they provide. In return, GPs will agree to work with us on much-needed reforms including more cost-effective prescribing of medicines, waiting list validation and use of new ICT systems."
Minister for Health Simon Harris said “This agreement is a landmark for the health service. For the first time we will see the structured care on a large scale of patients with chronic conditions in a primary care setting.
"I am delighted also that GPs will engage strongly with the exciting eHealth agenda which will enable safer, joined-up patient care and will also help the health service to greatly reduce the use of outmoded paper-based communications and record-keeping.”
The Department of Health, the HSE and the IMO have agreed a set of measures on the provision of new services, including a structured chronic disease management programme, commencing in 2020, which will benefit over 430,000 Medical Card and GP Visit Card patients over the next four years.
GPs will also be paid to provide venesection for patients with haemochromatosis, which will mean that 8,000 GMS patients with this condition will no longer have to attend hospitals for therapeutic phlebotomy.
A wide-ranging set of modernisation measures has also been agreed in the areas of eHealth, medicines management and multidisciplinary working. Key initiatives include the rollout of electronic prescribing (ePrescribing) and the development of summary and shared care electronic patient records which will make healthcare safer and more efficient.
The introduction in 2019 of a system of pharmacist-led medication reviews will facilitate safer, more appropriate and more cost-effective prescribing. GPs will also for the first time formally cooperate with HSE multidisciplinary networks of health professionals in the community in the delivery of care, with a particular focus on those with complex needs.
In return for GPs’ cooperation with these service developments and reforms, the Government will increase investment in general practice by approximately 40% (€210m) over the next four years.
This will see significant increases in capitation fees for GPs who participate in the reform programme and the introduction of new fees and subsidies for additional services such as the chronic disease management programme.
There will also be increased support for rural practices and for those in disadvantaged urban areas. The rural practice allowance will be increased by 10% in 2020 and targeted funding of €2m annually will be set aside to provide additional support to practices in deprived urban areas.
These measures will contribute to making general practice more sustainable in rural areas and in areas with particular socio-economic challenges.
Improvements to maternity and paternity leave arrangements for GPs have also been agreed, in recognition of the need to ensure that general practice is compatible with doctors’ family commitments.
The agreement includes proposals to Government to extend GP care without fees to children aged 6-12 on a phased basis, starting in 2020.
Speaking today, the Taoiseach said: “The Minister for Health and I are also signalling our intention to extend the free GP care scheme for children which currently applies to children aged five and under, to all children aged 6-12.
“Alongside the new staff nurses contract agreed with unions earlier this week and the reduction in prescription charges and the widening of income limits for the GP Visit Card, I believe this represents a major step forward in the implementation of Slaintecare, increased resourcing of primary care, transferring chronic disease management from hospitals to the community, and widening the provision of free and subsidised healthcare.”
Minister for Health Simon Harris said “This agreement shows that Government is delivering on the Sláintecare programme – the agreement of a revised GP contract will enable the delivery of integrated, community-based care that is provided at the right time, in the right place. I appreciate that GPs have been under pressure in recent years to maintain services in the face of increasing demand and stretched resources. The funding stream that will flow in return for the changes we are announcing today will put general practice on a much more sustainable footing and help to make it an attractive and exciting career choice for doctors.”
ENDS
Notes to the Editor
Background
Approximately 2,500 general practitioners hold contracts with the HSE to provide services to GMS (medical card) patients and persons who hold a GP Visit Card (GPVC).
At 1st March 2019, a total of 2,069,874 people – 42.6% of the population, now has access to free GP care:
- Approximately 1.56 million people or 32.1% of the population have a medical card, and
- over 500,000 people or 10.4% of the population have a GP visit card.
Total payments to GPs under the GMS scheme in 2017 amounted to approximately €525 million in respect of services for just under 2.1 million people (44% of the estimated population).
GPs also receive payments under public health schemes, such as the Primary Childhood Immunisation Scheme, Maternity and Infant Care Scheme, etc.
The current phase of talks got underway in October 2018 with the focus on a range of modernisation, reform and sustainability measures to better meet the needs of patients while also aiming to promote general practice as a viable and rewarding career for existing doctors and future medical graduates. Key elements of the agreement are as follows.
Service Developments
Chronic Disease Management Programme (Diabetes, Asthma, COPD & Cardiovascular Disease)
A Chronic Disease Management Programme for GMS/GPVC patients will commence in 2020 and will be rolled out to adult patients over a 4-year period with a target uptake rate of 75%. The Programme which is comprised of three components envisages an uptake of 431,000 patients;
• 120,500 on the Opportunistic Case Finding Programme, involving the opportunistic assessments in order to detect and diagnose diseases at an early stage, so that they can be appropriately managed
• 253,500 on the CDM Structured Programme with 2 GP visits and 2 Practice Nurse visits a year
• 57,000 on the High Risk Preventative Programme with 1 GP visit and 1 Practice Nurse visit a year
The first phase of the Programme will target patients over 75 years with the Opportunistic Case Finding and Preventive components of the Programme commencing in Year 2.
The chronic diseases which will be included are;
• Diabetes Type 2
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Cardiovascular Disease including:
o Heart Failure
o Ischaemic Heart Disease
o Cerebrovascular Disease (Stroke/ Transient Ischemic Attack (TIA))
o Atrial Fibrillation
Haemochromatosis
Under this agreement GMS patients with haemochromatosis will no longer have to attend hospitals for therapeutic phlebotomy. Instead this service will be provided locally by their GP which will be more convenient for patients and transfer this activity from a hospital to community setting. It is estimated that this will benefit some 7,000 – 8,000 patients who normally require 3 therapeutic phlebotomy sessions per annum.
Service Reforms and Modernisation
eHealth
A significant feature of the agreement will be the rollout of a number of eHealth initiatives over the lifetime of the agreement.
The Individual Health Identifier (IHI) will be utilised for all patients. Electronic summary care records will be developed for each patient – these records will be accessible to clinicians in other healthcare settings such as Emergency Departments and Out-of-Hours services, enabling them to provide better and safer care to patients. Shared Care Records will also be developed to make available an electronic longitudinal record of a patient’s care in different healthcare settings. Anonymised data from electronic records will be capable of use for management of the health system and for statistical and research purposes.
E-prescribing will start to be deployed in 2021 and medication information from this system will auto-populate the summary and shared care patient records. There will be increased usage of diagnostic imaging services such as NIMIS and cooperation with the initial deployment of the MEDLIS system, used to order laboratory tests, from 2020 onwards. The use of these systems will enable more streamlined and efficient communication between hospitals and general practice.
Medication Reviews and Medications Management
An important development is an agreement that GPs will cooperate with the HSE Pharmacists who will carry out medication reviews, initially for patients over 75, starting in 2019. The output of these reviews will be provided to the GP, who may adjust the patient’s medication regime where this is clinically indicated. This will lead to safer, more appropriate and more cost-effective prescribing. The introduction of medication reviews is regarded as of critical importance to the health service in terms of patient safety and as a value for money initiative.
Development of Multidisciplinary Care/Community Health Networks
GPs will participate formally in multidisciplinary care arrangements in the HSE Community Healthcare Networks. Initially there will be one learning site per CHO, to trial and refine the arrangements, and this will be followed by national implementation across all 96 Networks. This will be a significant development in that GPs will for the first time be signing up to structured working with a range of HSE healthcare professionals in the community, focused in particular on integrated responses to the needs of patients and communities with more complex health and social care issues.
Waiting List Validation Exercises
GPs will cooperate with the NTPF’s National Central Validation Unit’s exercises.
Improved Family-Friendly Arrangements for GPs
It has been agreed that the locum rate for GPs availing of maternity leave will be increased. The paternity leave allowance will be extended from 3 days to 2 weeks, at the same increased locum rate as for maternity leave.
Involuntary Admissions under the Mental Health Act
It has been agreed that a new fee will be paid to GPs who assist in cases of involuntary admissions under the Mental Health Act.
Virtual Clinics
It has been agreed to pay GPs a fee for participation (in four pilot areas) in weekly virtual consultations with Consultant Cardiologists to discuss patients with heart failure and agree/amend care plans for these patients. These clinics will divert patients from acute settings and OPD waiting lists. There currently is a pilot in Carlow/Kilkenny area. This will be extended and a further 3 clinics will be established with 4 clinics in place over 2019 to 2022. This will provide 17,500 virtual clinic slots per year when fully implemented during which one of more clients will be discussed.