Speech by Minister for Health, Simon Harris TD, Irish College of General Practitioners

Annual Conference & AGM – 3 May 2019

 Introduction

Good Evening, Ladies and Gentlemen,

Firstly, I want to thank your Chief Executive, Fintan Foy, CEO, for the invitation to address your conference today.

I would also like to thank Dr John O’Brien, outgoing ICGP President, for all your hard work over the past year.

And of course I must congratulate Dr Mary Favier, incoming President – I look forward to working with you in the months ahead, Mary.

The range of issues on your conference programme reflects well the challenges and priorities for the health service today.

That is no coincidence as General Practice is the very heart of our health service and becoming ever more central in the era of Sláintecare.

 General Practice

Every day – without fail – thousands of you around the country literally save lives – and we don’t see that in the headlines or hear it on the Nine O’Clock News!

But throughout your career, you as a GP save dozens of lives – more than any other doctor.

This may not always be recognised because it doesn’t come with blue lights flashing – rather, it’s a hand on the shoulder, reassuring, monitoring, listening. Treating patients. Guiding patients on what’s best for their health, and how to get better, or live with a chronic illness.

There’s a HSE campaign that says “Make Every Contact Count” – well that’s what general practitioners do – 27 million times a year!

GP Training

I wish to acknowledge the work being done by the College in expanding the number of training places for new GPs. Some 700 GPs are due to retire in the next six years, and there will be growing demand for GPs as our population grows older.

We have seen a 50% increase in applications for training places in the last two years – that’s good news.

It shows the success of your social media campaign – BE A GP – which highlighted the advantages of a career in general practice.

It also shows that general practice continues to be a popular choice for medical graduates.

I know the College can facilitate increased numbers to meet increased demand.

This year the College has filled almost 200 places in training – that’s a great achievement.

I acknowledge that transferring the management of training of GPs from the HSE to the ICGP is a priority for you and I am committed to achieving that.

 Retention

Yet, as we train more GPs, the challenge is to retain as many of them as possible to work here.

The College’s 2017 survey of recent graduates showed that one in five graduates said they would not return once they left.

I hope to work with the College to meet this challenge of retaining these accomplished and well-trained doctors – and I know the reformed GP Contract and reversal of FEMPI is a big step in the right direction in ensuring that general practice is seen an attractive career for our medical graduates.

We need to encourage those who have left to return – and return soon.

It is important that young GPs see Ireland as the first port of call when deciding where to go when finished their training.

I hope that by working with the College, the HSE, the Department and Unions, we can be creative in ensuring greater levels of retention.

Not only do we need to attract younger GPs, we also need to retain those in practice and also look after those who wish to retire. We have a huge amount of work to do, but I am committed to working with all stakeholders to ensure General Practice is in a position that best supports patient care and GPs themselves.

 GP Contract

In light of all of this, I am pleased to be speaking to you today in the context of the recently concluded GP contract talks.

I am satisfied that, working together, we have delivered a comprehensive service development and reform agreement in return for very significant phased increases in funding for general practice for the services provided to GMS patients.

This agreement represents a major step forward in the implementation of Sláintecare, with increased resourcing for primary care and an expanded range of healthcare services available in the community.

 Increased Investment for General Practice

Alongside service developments and reforms, the Government will increase investment in general practice by approximately 40% – 210 million euro – over the next four years.

This will see significant increases in capitation fees of approximately 48% for GPs who sign up to participate in the reform programme and the introduction of new fees and subsidies for additional services such as the chronic disease management programme.

There will also be increased support for rural practices and for those in disadvantaged urban areas. The rural practice allowance will be increased by 10% in 2020 and targeted funding of €2 million annually will be set aside to provide additional support to practices in deprived urban areas.

These measures will contribute to making general practice more sustainable in rural areas and in areas with particular socio-economic challenges.

Improved Family Friendly Arrangements for GPs

Improved family friendly arrangements are an important feature of the revised contractual arrangements, with an increase in the locum rate for maternity and paternity cover, and an increase in the paternity leave allowance from 3 days to 2 weeks. This is in recognition of the need to ensure that general practice is compatible with doctors’ family commitments.

GP Contract: Next Steps

The HSE is now drafting a circular that will set out the terms of the contractual changes agreed. This will issue in the coming weeks to all GPs who hold a GMS contract.

Individual GPs will be invited to confirm their acceptance of the contractual changes which will make them eligible for the new fees which will come into force on 1 July.

I look forward to your engagement with this process and hope to see the majority of GPs signing up to the agreement and benefitting from these significantly increased resources later this year.

The reformed GP contract will support the Sláintecare vision of strong inter-disciplinary working and, crucially, reform the management of chronic illness so that hospital stays are prevented or minimised. The eHealth initiatives are particularly important and will lead to safer, more integrated patient care.

However, it is fair to acknowledge that not everything that the parties might have wished to achieve has been resolved in these negotiations.

There is also a need, in the Government’s view, for a longer-term strategic review of how general practice should operate within the health service, well into the future.

Therefore, during the lifetime of this agreement my Department will lead a strategic review of general practice with a view to developing a new contractual framework which best supports patients and encourages innovation in primary care. This will be a wide-ranging task and it will, I hope, enable further innovative measures to be developed for the benefit of citizens and of course for GPs.

 Vaccination

As you know, I have been focusing a lot of my attention on vaccination.

In an era of fake news and false internet claims, General Practitioners play a vital role in communicating the benefits and safety of vaccines to parents, and individuals.

I am confident that GPs will help to promote the pro-vaccine message and I urge you all to support the drive to encourage uptake.

I know that in many of your practices, you have a 100% success rate. That’s due to the trust that your patients put in you, and I want to acknowledge the work that GPs do already to support vaccination.

 CME Network

The CME Network is an essential part of the general practice in this country and in the educational role the College provides. As GP numbers increase, there will be a greater demand for CME and I am aware that this will require appropriate funding. The HSE and my department will work closely with the College on this matter.

 Contraception

In October 2018 the Global Conference on Primary Care recognised the centrality of Sexual and Reproductive Health in Primary Care.

In Ireland, the majority of contraception provision is provided through General Practice. A range of contraception is widely available here, but availability of contraception should not be confused with accessibility.

I am aware of the frustration of many GPs that a comprehensive women’s health programme does not include free contraception for everyone.

I have made this a priority and established a working group in my Department specifically to progress work on contraception. I recognise the necessity of hearing GPs’ views on this and I can assure you we will listen. We are also well advanced in developing a Women’s Health Action Plan for publication this year, which I believe will be another important step forward.

 A Brighter Future

Returning to the new agreement reached with the IMO, it enables us to expand the management of chronic disease through general practice.

For the first time, GPs will deliver structured care on a larger scale to patients with chronic diseases in primary care.

Over 400,000 patients with chronic illness – such as diabetes, asthma, COPD and heart disease – will benefit from this new programme.

I welcome the appointment of the Clinical Leads in these four areas by the College.

I also welcome the engagement of the College at the highest level with Slaintecare because, without general practice, Slaintecare cannot achieve its aims. I am committed to resourcing Slaintecare to ensure that we move to a more community-based model of care in the coming years.

 A Challenging Year

I know that the last few years have not been easy for GPs and that it has not been an easy year for the College either.

ICGP is a membership organisation which represents over 3,600 GPs and I know for many, this year in particular, has been difficult.

It is at difficult times like this when real leadership is required and I would personally like to acknowledge the fine leadership qualities shown by the College’s President – Dr John O’Brien – he exemplifies what is best about general practice and indeed the College.

I think it is also important to note that a strong College with a vibrant, questioning and challenging membership, particularly at this time, is one that will bring huge benefits to general practice and the patients you care for.

And I can’t finish without acknowledging Dr John Gillman, who steps down as Chairman of the College later this year.

His good humour and leadership style will be very much missed at the top table.

 Conclusion

In conclusion, I will reiterate – general practice is the cornerstone of the Irish health service.

While the media headlines are often dominated by hospitals, it is the unsung day-to-day consultations, the cradle-to-grave service, the listening, and the understanding, that makes general practice what it is.

The flexible, innovative and people-centred model of care must remain at the cornerstone of Irish healthcare.

I want to see general practice grow in strength and remain at the heart of excellent care for our communities now and in the future.

Thank you.