A report on the future of general medical practice recommends that family doctors undergo formal auditing and an annual verification visit by health board staff.
The report, Developing General Medical Practice, has been drawn up by health board chief executive officers. It is a comprehensive analysis of the future needs of primary medical care, and sets out a detailed work programme to implement changes in the way healthcare is delivered.
Seen by The Irish Times, the report proposes a greater involvement by patients in the running of general medical practice. General practitioners would be asked to "make adequate provision for meaningful involvement of service users in the planning, delivery and evaluation" of their service. Practices would be expected to put in place mechanisms for patient satisfaction feedback.
Local communities would be surveyed by health boards to assess the range of health services provided in each district.
The report also calls for minimum quality standards in general practice. "Services will require to be effective in terms of outcomes achieved", it states in a reference to immunisation levels and the uptake of screening initiatives.
Early detection of cancer would be facilitated by written protocols to ensure the urgent referral of patients to hospital. These would be agreed and written up in consultation with hospital specialists.
The chief executive officers also propose the establishment of population health units in each health board area. The units would be responsible for setting up preventive screening programmes for heart disease, cancer and children's health as well as monitoring their success.
The report proposes a development programme to improve the capacity of family medicine to deliver new preventive medical services. A key element of this would be personal doctor selection. Under a new system, people without medical cards would be invited to identify their doctor of choice so that each practice would have a patient register on which to base health screening programmes.
The report also advocates a formal audit and verification process for primary care. This would involve an annual report by medical practices, the monitoring and analysis of information from practices by health board managements, and an annual verification visit by audit staff from the local health board. "Examination of a practice activity could take place if required for any special reason," the document states.
The chief executive officer of the North Western Health Board, Mr Pat Harvey, said the document was an integral part of Health Strategy 2001. "There is a huge opportunity for the development of general practice. I look forward to working `elbow to elbow' with the GP representative organisations on these proposals." Asked why the document did not refer to the financial implications of the proposals, Mr Harvey said the CEOs wished to concentrate on agreeing the elements of future general practice with doctors before dealing with the cost issue.
Dr James Reilly, chairman of the Irish Medical Organisation GP Committee, welcomed the report's acknowledgment of family doctors' central role in preventive medicine. However, he said, "the over-emphasis on accountability and increased efficiency will anger GPs who are providing an excellent day-today service despite chronic underfunding".
The chief executive of the Irish College of General Practitioners, Mr Fionn O Cuinnegain, said the report was "the first integrated effort on the part of heath board CEOs to make proposals for the development of general practice services in the future".