HSE proposals: Family doctors have criticised some elements of the Health Service Executive's (HSE) proposals for the development of general practice.
In a position paper circulated to members, the Irish College of General Practitioners (ICGP) has rejected a HSE proposal for two types of contract under which GPs would treat medical card patients.
The representative body for family doctors in the Republic is concerned the proposal would lead to a two-tier level of service. It says it wants all practices to be eligible to become primary care teams.
Emphasising its broad welcome for the HSE analysis of the current state of general practice, the council of the ICGP said it "welcomes the various encouraging statements on the role of general practice and primary care by Prof Brendan Drumm, HSE chief executive, and his adviser, Dr Sean McGuire". The document specifically supports the development of community intervention teams and the reorientation of the health service towards primary care.
However, it labels as "unacceptable" the idea of both a standard and an enhanced contract for GPs. Enhanced contracts would be offered to GPs working together in groups of three or more. Under this contract, the practice would offer chronic disease and preventive services in addition to standard GP care. "This proposal appears to suggest a permanent two-tier service [ some practices will offer chronic disease management, while others will not]. This is unacceptable," the ICGP says.
While emphasising that the contractual aspects of a new GP deal were an issue to be dealt with by the Irish Medical Organisation (IMO) and the HSE, Dr Eamonn Shanahan, chairman of the ICGP, said: "It is unacceptable to GPs that there would be the perception of two levels of care by practices.
"We have always promoted the same level of care to all patients irrespective of their background. Our concern is that this will mean a two-tier form of general practice."
A spokesman for the HSE said: "Under no circumstances does the HSE perceive the enhanced contract to represent a two-tiered system. This is an evolving situation and is not permanent. We recognise there may be GPs that do not wish to provide the range of services required for chronic disease management. But the HSE hopes that all GPs will eventually hold an enhanced contract."
In a reference to a budget proposal to form 100 new enlarged primary care teams this year, the ICGP document says: "Should we not make a similar sum available to any practice submitting plans for service development?"
Dr Shanahan said he is concerned that these 100 practices will be seen as a chosen few. "Let all practices put themselves forward, irrespective of their size," he said.
A spokesman for the HSE said it does not intend picking out practices. "All of those who are interested can apply. A standard letter will be going out soon to all GPs asking them if they wish to become part of a primary care team. This will be the first phase of an ongoing process."
He welcomed the ICGP document as a useful contribution to the debate around the significant changes expected over the coming years in primary and continuing care.