Greater range of services from GPs sought

The Government is seeking to have family doctors open their surgeries for longer each day and to provide a greater range of services for patients under new reforms of the organisation and structure of general practice.

The Government also wants new arrangements which would make GPs accountable for how they spent State funding. It has also proposed that GPs should have to undergo peer review of their clinical practice and engage in continuing medical education programmes.

The proposed reforms would also see a new emphasis placed on GPs prescribing cheaper generic drugs for patients where appropriate. The general medical service, which includes the medical card scheme for 30 per cent of the population, now costs well over €1 billion per year to operate and the Government has been seeking reforms in this area for several years.

The reform proposals are contained in a confidential outline position set out by health service management to the Irish Medical Organisation last week as part of an overall review of the general medical service.

It is understood that at the talks senior officials of the Health Service Executive and the Department of Health said the Government wanted a fundamental review of the nature of services provided by GPs and not just a tweaking or modification of the existing contract.

Health service management last week set out the headings for reform sought by the Government. Full specific details on these will be provided at substantive negotiations to be held in the weeks ahead. It is understood that in some areas political direction will be required.

It is understood that management proposed that GPs should provide more services early in the morning or later in the evening to facilitate patients who work during the day.

Under the proposals patients would also be able to receive more diagnostic tests in GPs' surgeries rather than having to be referred to hospital. The proposals envisages a greater use of information technology by family doctors and suggest, for example, GPs would be able to receive correspondence from hospitals regarding patients on-line rather than through the post.

It proposes that patients with chronic conditions and those with minor injuries should be managed in the community rather than in hospitals. It gives an example of diabetes as one such condition which could be managed at primary care level.

The Government reforms also propose that GPs could play a greater role in disease prevention. It suggests that GPs could provide regular health check-ups, disease screening and monitor blood pressure.

The Government proposals acknowledge that greater manpower is required in general practice.

The reforms propose increasing the number of doctors with contracts to treat medical card patients. It is understood that management has maintained that it is difficult in some parts of the country for young doctors to get a medical card "list" except in the case of a death or resignation of an existing GP. At the same time in other regions there is a shortage of GPs.

The Government proposals would see a liberalisation of the criteria for doctors to gain entry to the medical card scheme.

The Government has proposed that given the changes in the demographics of general practice - where a majority of GPs will soon be young women - a more flexible, family-friendly contract be introduced.

Sources said that management believed that funding should be incremental and dependent on efficiency and success and not the other way around.

Management believes that any new contract should also make provision for the Government to introduce new services in the years ahead without having to negotiate with GPs It is understood that management has also proposed that a new contract should be agreed first with the IMO and then sent to arbitration for a price to be put on it rather than having lengthy negotiations on fees for each individual element.

Informed sources said that at the talks there was a wide degree of convergence between the positions of management and the IMO. It is understood that doctors said that they could provide additional services but stressed that the current service was under-resourced and that large-scale investment was needed.