There has been a long-running joke at the top of Government as to whether Theresa May would secure her Brexit deal before Simon Harris reached a new agreement with general practitioners.
Governments of various hues have for years been talking about the need to modernise the decades-old accord between the State and family doctors. The Government’s Sláintecare health reforms as well as the economic necessity to move patient care from the expensive hospital sector to the community made it an imperative.
A Department of Health future capacity analysis last year forecast that a growing and ageing population would need 2,600 additional hospital beds if the Sláintecare reforms were introduced but if the shift to care in the community did not take place about 7,000 more hospital beds would be required - a figure largely considered to be unaffordable.
However there were also considerable political forces at work behind the Government's decision to sign up to a €210million deal with the Irish Medical Organisation on Friday.
A wave of financial cuts during the economic crisis had, according to doctors, brought general practice in Ireland close to collapse.
Where traditionally family doctors provided a same-day service, patients were increasingly facing waiting lists of sometimes a number of days for a consultation.
In the growing commuter-belt towns young families were finding existing practices were full and were not taking on new patients. In some parts of the country there were no GP s at all. Young GP s were opting to work abroad after they finished training while, in a major break with tradition, some more experienced practitioners were shutting up shop and moving abroad.
GP s ran a highly effective campaign to highlight the state of general practice.
Local TD s were getting grief from patients and doctors and, in turn, Harris was getting it in the neck from his colleagues at Fine Gael parliamentary party meetings on a regular basis .
Harris was also feeling the heat from his boss, Taoiseach Leo Varadkar who has for some time been putting pressure on the Department of Health to get the deal concluded.
An agreement with family doctors marks a major milestone in the implementation of Sláintecare and could also address the local campaigns for improved GP services.
However a new accord also opens the way to introducing the Government’s long -held ambition to extend existing free GP care arrangements.
Varadkar as Minister for Health had put in place a free family doctor scheme for children under age six. The programme for government said this should be expanded to all children up to 18.
However there was not a hope in hell of the IMO agreeing to extend this service unless the Government reversed the €120 million in cuts imposed during the austerity years.
Election campaign
The new proposals will allow the Government to campaign at the next election on the basis of a plan that would see all primary school children having free GP care.
Only last Wednesday Harris and the Minister for Social Protection Regina doherty also launched a new initiaitve on dental care for children. The building blocks for an election manifesto are being put in place.
The new agreement reached on Friday goes beyond just rolling back cuts.
However the accord will not come cheap.
About 2,500 GP practices with contracts to operate the medical card scheme for the State will receive more than €200 million between them over three years as part of a reveral of previous cuts a nd the introduction of new fees for additional services.
To put this in context the overall public service pay agreement for more than 300,000 civil and public service staff will cost about €900 million over three years.
In return for an investment of €120 million to effectively reverse the cutbacks over recent years, GPs will co-operate with the rollout of a number of eHealth initiatives including the introduction of individual health identifier (IHI). E-prescribing by GPs will start to be deployed in 2021.
There will also be a separate €80 million initiative. A chronic disease management scheme for patients with medical cards and GP visit cards will commence in 2020 and will be rolled out to adult patients over a four -year period.
The conditions covered by the initiative will be:
- Diabetes Type 2
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Cardiovascular Disease including:
- Heart Failure
- Ischaemic Heart Disease
- Cerebrovascular Disease (Stroke/ Transient Ischemic Attack (TIA))
- Atrial Fibrillation
Separately under the agreement, medical card patients with with haemochromatosis will no longer have to attend hospitals for therapeutic phlebotomy. Instead this service will be provided locally by their GP , amove which the Government believes 7,000 - 8,000 patients who normally require 3 therapeutic phlebotomy sessions per annum.
