Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am pleased to be here this evening to update the House on the outcome of the recently concluded general practitioner, GP, contract talks. I genuinely believe this represents a major step forward in terms of the implementation of Sláintecare, with increased resourcing for primary care and widening the range of healthcare services available in the community.

I acknowledge the important role GPs play in the delivery of our health service and to their commitment to providing a responsive and high-quality service to patients. I am aware that the workload in many GP practices remains very heavy and that the last few years have been particularly challenging.

I recognise also that GPs working in rural and socially deprived areas play a particularly important role in ensuring the availability of health services in their communities. I assure the House that the Government is committed to ensuring that general practice in such areas remains a sustainable and attractive option for doctors. Members will see a number of new initiatives in this new and comprehensive agreement that make that a reality.

The Government, mindful of the difficulties in general practice and in keeping with its commitment to the continued development of GP services, agreed a mandate in 2018 for GP contract talks that would seek to secure agreement on the introduction of new service developments, to include a chronic disease management programme, as well as a suite of reform and modernisation measures. Owing to the range and complexity of the issues to be discussed, the engagement process took a significant amount of time and effort by all parties involved. Following detailed and intensive engagement, the talks finally concluded on 3 April.

The outcome of the process is a comprehensive service development and reform agreement in return for very significant phased increases in funding for general practice for the services provided to medical card and GP visit card patients. This agreement with the IMO is a major milestone for the health service. It provides for a significant package of measures that will benefit patients and also make general practice a more attractive career option for doctors. This is important. We have tried to get the balance right between the introduction of new services and the modernisation agenda, but of recognising, as the Chairman of the health committee reminds me regularly, the need to make the existing services sustainable, and recognising that doctors took significant cuts and hits during the financial recessionary years. We have got the balance right in this agreement.

For the first time we will see the delivery of structured care on a large scale for patients with chronic conditions in the primary care setting. Over 400,000 medical card and GP visit card patients with chronic illness, such as diabetes, asthma, COPD and heart disease, will benefit from new and improved chronic disease management. These patients, who would have been seen in the hospital, are now being seen in the community. They are also patients who, through more regular check-ups, can maintain better health with their chronic conditions.

The programme will start in 2020 and will be rolled out to adult patients over a four-year period, starting, appropriately, with those aged over 75. Patients with an existing diagnosis of one of the specified conditions, those who are assessed by their GP on an opportunistic case-finding basis, in addition to those identified as high risk, will benefit under the new programme.

GPs will be paid to provide services for patients with haemochromatosis, which will mean some 8,000 with this condition will no longer have to attend their hospital for therapeutic phlebotomy but can be managed locally by their GP. This could save patients up to three visits a year to the hospital and will also free up very significant resources in the hospital setting.

It has been agreed to pay GPs a fee for participation in weekly virtual consultations with consultant cardiologists to discuss patients with heart failure and agree or amend care plans for these patients. This is a really good example of using technology and integrated care, and of hospital doctors and GPs working together to discuss cases. These virtual clinics will divert patients from acute settings and outpatient department waiting lists. A pilot currently in operation in the Carlow-Kilkenny area has shown a 95% decrease in referral for admission and an 87% decrease in referral to outpatient departments of these patients. The clinics clearly work. The pilot will be extended, and a further three clinics will be established, with four in place over 2019 to 2022. This will provide 17,500 virtual clinic slots per year when fully implemented during which one or more patients will be discussed.

I welcome the agreement by GPs to co-operate with waiting list validation exercises. This will ensure more accurate and current waiting lists, improved access to services and better outcomes for patients.

A wide-ranging set of important modernisation measures also been agreed in the areas of ehealth, medicines management and multidisciplinary working, as well as the increased use of diagnostic imaging and laboratory services.

Over the next four years, patients, GPs and the health service as a whole will significantly benefit from these initiatives. I particularly welcome GPs’ agreement to engage strongly with the exciting ehealth agenda, another key Sláintecare initiative, 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. We need to move beyond the paper file to electronic health records.

Over the next number of years, GPs will engage in a wide range of important ehealth initiatives, including the rolling out of electronic prescribing, which will enhance the safety and quality of the prescribing process; and the development of summary and shared care electronic patient records, which will give GPs and other healthcare professionals access to important patient information.

The introduction in 2019 of a system of HSE pharmacist-led medication reviews, initially for patients over 75, will facilitate safer, more appropriate and more cost-effective prescribing. GPs will also for the first time formally co-operate with HSE multidisciplinary networks of health professionals, again key to the delivery of Sláintecare.

In return for all this, the Government will increase investment in general practice by approximately 40%, or €210 million, over the next four years. This will see very significant increases in capitation fees for GPs who sign up to participate in the reform programme and the introduction of new fees and subsidies for additional services, such as chronic disease management. Very important, we will also increase support for rural practices and for those in disadvantaged urban areas. The rural practice allowance will be increased by 10% in 2020 and, for the first time ever, targeted funding of €2 million annually will be set aside to provide additional support to practices in deprived urban areas. This is an important development.

Crucially, we will introduce improved family-friendly arrangements for GPs, increasing the maternity and paternity cover for GPs to try to help make general practice a more attractive career option.

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