"We have had 30 years of the General Medical Services Scheme. It must now be replaced." These were the uncompromising words of the Irish Medical Organisation's GP committee chairman, Dr James Reilly, as he outlined recent changes to the scheme at the organisation's a.g.m. at the weekend.
The changes are at best sticking plasters to the many gaping wounds in the medical card scheme. They allowed the IMO to pull back from industrial action which would have hit the State's vaccination scheme. However the use of the words "interim" and "once-off" throughout the agreement betray a recognition that an overall review of primary care services is now required.
A joint IMO/ICGP policy statement, "A Vision of General Practice - Priorities 20012006", will be introduced next weekend at the Irish College of General Practitioners' a.g.m. in Westport. Taken with the health board CEOs' recently completed review of GP services and the ongoing discussions for a new health strategy, it is clear all aspects of primary care are now in the melting pot.
There is considerable support for the Labour Party health policy among doctors. GPs would be quite happy to let go of the private part of their practices in return for a properly structured and funded insurance-based system for every patient in the State. The Government would pay the premium for the 40 per cent or so of people with the lowest incomes, with the remainder paying insurance premiums to the VHI, BUPA and other insurers who might enter the market.
They will certainly have been heartened by Dr Cormac Macnamara's outline of gross earnings of £250,000 for the average GP, which would include minimal practice expenses of £140,000. And while the Government will have noted that he did not specify how many patients a GP would look after for an annual salary of £110,000, it must accept that a properly developed primary service will require significant funding.
The most important change for patients will be guaranteed access to a GP for all sections in society. At present there is a significant group for whom basic healthcare is a luxury, to be availed of when they have the money. Those above the paltry income limits for a medical card are unable to afford preventive medical care on an ongoing basis. With GPs seeking to have smaller lists of patients, a new scheme should ensure longer consultation times for everyone. Not only will this allow for an expansion of services in primary care but it should also help to minimise medical mistakes and reverse the spiralling rates of litigation.
For people with chronic illness, a revamped system will also see the development of proper teamwork in primary care. General practitioners and public health nurses will be responsible for the same list of patients and will plan their work together, unlike the present system of working in disjointed isolation.
In future, everyone in the State will be encouraged to register with a general practitioner. This will require a system of universal patient registration (UPR). A patient will nominate a GP who will provide medical care, including preventive services and screening, and will hold a comprehensive medical record on their behalf.
UPR will ensure that preventive services such as those outlined in the cardiovascular strategy will be targeted at people who need them most. It will also help monitor standards of chronic care.
The most important change the system needs is to provide equitable and fair access to healthcare. Which is why our primary care system needs to be rebuilt from the ground up.