• The committee’s vision cannot be implemented without a new GP contract that restores and sustains the viability of general practice, enabling it to lead and develop integrated care
  •  Free GP Care may only be considered when capacity is addressed, resources are provided and a new contract is agreed with general practice
  •  Calls for an “impact study on Free GP Care” to “avoid and limit unintended consequences” to patients and providers, to mirror that proposed by the committee for consultants and hospitals
  • NAGP call on Minister for Health to urgently develop an accelerated and meaningful process for GP contract negotiations with realistic goals leading to measurable progress within 6 months

Responding to the publication of the Future of Healthcare Report, the National Association of General Practitioners (NAGP) caution that the report can only be implemented by restoring viability to general practice through reinvestment and the successful negotiation of a new GP contract.

The NAGP welcomes the committee’s recognition that “existing capacity is exhausted” in general practice and “capacity must first be addressed”. Increasing the number of GPs, practice staff and practice nurses will be critical in building a successful community team approach to healthcare. The NAGP therefore calls for immediate resourcing of general practice to restore functionality and viability. This can be partially addressed through unwinding the disproportionate FEMPI cuts imposed on general practice – a process now formally underway for other health sector workers but from which general practice is currently excluded.

The NAGP cautions that the negotiation of a new GP contract must be accelerated with the equal involvement of all the parties, or implementation of the report will not happen.

Dr Emmet Kerin, President of the NAGP, speaking after the publication of the report, said “I’d like to thank the Oireachtas Committee on the Future of Healthcare for its dedicated work over the past year to deliver a 10-year plan for health care in Ireland. This report will help take politics out of health and give direction and clarity to the decisive shift to primary care that is required to redress our current failed hospital-centric model of care.”

However, Dr. Kerin warned, “Progress on a new GP contract has been too slow and fragmented. At the current rate, we are unlikely to see a new contract agreed within three years. A new fit-for-purpose contract would underpin much needed reform in our primary care health service. Failure to produce a timely new contract would be an unforgiveable obstacle to the delivery of the vision set out in this report”.

Dr Kerin continued, “Progress on the contract has been very slow and is not helped by the parallel negotiation processes taking place which has only served to create more silos. The NAGP warned that this approach would not be in the best interests of GPs or patients and we repeat our stated position that we would prefer that all parties to negotiations were in the same room and there was an agreed time-frame to deliver a contract. We must ensure that we all play our part equally in delivering the health service that patients deserve. I am calling on the Minister for Health to bring GP contract negotiators into the same room and remove the barriers to meaningful progress that the parallel process has created”.

The GP union welcomed the following principles that have been highlighted in the report:

  • More care for patients delivered in the community
  • The implementation of an integrated care system
  • The development of general practice
  • Enhanced teams working in primary care with GP leadership
  • Better access to community diagnostics through service hubs
  • Ring-fenced transitional funding underpinned by legislation
  • An emphasis on clinical leadership, governance and State accountability

Dr Kerin went on to say, “There are many positives in this report and many challenges. There will not be 100% agreement on certain recommendations. Extension of free GP care over five years, while utopian, will currently destabilise an exhausted service, already working beyond safe capacity, unless realistic funding, manpower and infrastructural supports are front-loaded into general practice and agreed by all the parties from day one. The near-universally negative GP experience of the introduction of free GP care for under 6’s is a barrier to the implementation of this report as the day-time and out-of-hours service was overwhelmed not by ‘unmet need’, as stated by the committee, but by unyielding demand for free access for minor self-limiting conditions of low acuity which displaced access and clinical time for more appropriate GP consultations, including the sick and frail elderly. This added to the trolley crisis of 2015/16. Such ‘unmet need’ displaced real need in our more vulnerable patients. This was, and remains, bad medicine and is far from the person-centred care which is meant to respect all providers and patients equally.”

“Free GP Care is therefore an ideal but is never entirely free. There is a societal, economic and systemic cost as well as potential adverse implications on vulnerable patients whose access is displaced by the unintended consequences of universality.”

“To safeguard against repeating these unintended consequences it is vital that a new, fit-for-purpose, GP contract is negotiated and agreed by all the stakeholders as a matter of extreme urgency. Without such an agreed contract the report cannot be implemented effectively. We call upon the committee to ask the Minister to fast-track the new GP contract and to involve all the representative bodies in a new, equal, focused and meaningful negotiation process that can deliver the outline of a new contract within 6 months, restore confidence in general practice and begin to improve care for our patients in 2018”.

Dr Kerin also asks the committee and the State “to seek an independent impact analysis on the separation of private practice from the new, publicly funded, free-GP scheme to avoid and limit any unintended consequences that may arise to patients and providers from this separation. This should mirror the same recommendation made by the committee for consultants who are being asked to make a similar change in work practice.”

Despite the challenges ahead the NAGP does not want this report to end up on the shelves of Government buildings, like so many before. We support the spirit of new collaboration, the demographic imperatives for change and the need to work differently. We also believe that general practice should be at the heart of a new functioning and connected health system that puts the patient first. However, we cannot support change that isn’t properly resourced, funded and beneficial for our patients as well as for our members.

The NAGP again thank the committee for its hard work and for shining a light in the darkness of our troubled, unequal and fragmented health system.

This report is appropriately long and detailed with implications for patients, providers and the State. It requires careful analysis and consideration. We will reflect further, consult with our members and patients, and issue a more detailed response at that time.