This document discusses the General Medical Services (GMS) contract for general practitioners (GPs) in Ireland and opportunities to improve primary care delivery. It notes that the 1972 GMS contract is outdated and no longer suitable given changes in healthcare. The document advocates that GPs be given greater responsibility and resources to provide more services like minor procedures, echocardiograms, and chronic disease management. This would help reduce costs compared to hospital care and improve access for patients while keeping GPs as the center of the healthcare system.

2. AYRFIELD MEDICAL PARTNERS - OFFICIAL OPENING 2011

3. AYRFIELD MEDICAL CENTRE

4. THE GMS ELEPHANT
THIS IS WHAT WE CANT DO
WE CANT STICK WITH A CRISIS INTERVENTION CONTRACT
OVERRELIANCE ON SECONDARY CARE
NO BASIS FOR HEALTH PREVENTION

5. 1972 CONTRACT
• REPLACED THE DISPENSARY SYSTEM (POOR
RELIEF IRELAND ACT 1851)
• INITALLY FEE PER ITEM
• 1989 CHANGED TO MAINLY CAPITATION BASED
• CONTRACT OF SERVICE RATHER THEN A
CONTRACT FOR SERVICE

6. PURPOSE OF THE GMS CONTRACT
• PUBLIC PATIENTS HAVE ACCESS TO FREE GP
SERVICES
• HSE ACTS TO PURCHASE SERVICES FROM GPS
• CHOICE AND ACCESS FOR PUBLIC PATIENTS TO
SERVICES
• CHOICE OF GP FOR PUBLIC PATIENTS
• VALUE FOR TAXPAYERS MONEY

7. ITEMS OF SERVICE DILEMMA
• FEE PER ITEM FOR RANGE OF SPECIFIED
SERVICES
• SUCCESSFUL ITEMS LIKE CRYOTHERAPY, ECG,
FLU VACCINE AND PNEUMONIA VACCINE
• UNECONOMICAL – 25 EUROS FOR MINOR
OPERATIVE PROCEDURE
• 25 EUROS FOR COIL INSERTION

8. OUT OF DATE ITEMS
INSTRUCTION IN THE FITTING OF A DIAPHRAGM.
ADVICE AND FITTING OF A DIAPHRAGM.
DRAINAGE OF A HYDROC0ELE
PLUGGING OF DENTAL HAEMORRHAGE
REMOVAL OF LODGED OR IMPACTED FOREIGN BODIES FROM THE EAR, NOSE
AND THROAT.

9. WHAT GP’S CAN DO ?
• GPS ARE READY TO GO
• ALL ABOUT RESOURCES- 2 % OF HEALTH BUDGET
– 9 /10%
• THE POOR RELATION OF THE HEALTH SERVICE
• UNTAPPED POTENTIAL WITH HIGH SKILL SET

10. GENERAL PRACTICE-A BUSINESS WITH
EMOTION
• MODEL IS FINANCIALLY SUSTAINABLE
• ONLY ARM OF THE SERVICE WITHIN BUDGET
• PRIVATE SECTOR ATTITUDE TO PUBLIC HEALTH
• GPS NEED TO BE AT THE CENTRE OF HEALTH
PLANNING
• COST EFFECTIVE, PATIENT FRIENDLY AND
QUALITY

11. SUSTAINABLE PRIMARY CARE
CENTRE
FULLY GP DEVLEOPED AND OWNED
HSE AS ANCHOR TENANT
PRIVATE HEALTH CARE PROVIDERS
SKIN IN THE GAME

12. QUALITY IN PRACTICE
• IS AN INTERNATIONAL OCCUPATIONAL HEALTH
AND SAFETY MANAGEMENT SYSTEM
SPECIFICATION
• ALLOWS FUFILL THE QUALITY MEASURE FOR THE
PRACTICE
• PRE HIQA
• EXPENSIVE

13. ECHO AND EXERCISE STRESS TEST
• CONSULTANT LED SERVICE
• ALL GPS ARE ACLS TRAINED
• PERFORMED BY CARDIAC TECHNICIAN
• TRIAGED AND REPORTED BY CONSULTANT
• SERVICE AGREEMENT HAVE THE ABILITY TO
DEBULK WAITING LISTS

14. ECHO AND CARDIAC STRESS TESTS
• RETROSPECTIVE CASE OF 223 ESTS FROM JULY
2012 TO APRIL 2013
• 18 WERE POSITIVE, 35 EQUIVOCAL AND 170
WERE NEGATIVE
• HIGH NEGATIVE PREDICTIVE RATE
• COST EFFECTIVE STRATEGY
• REDUCED BURDEN ON HOSPITAL RESOURCES

15. MENTAL HEALTH CLINIC
• CONSULTATION/LIAISON MENTAL HEALTH CLINIC
WAS SET UP IN APRIL 2010
• A SENIOR REGISTRAR PROVIDED A CLINIC EVERY 2
WEEKS
• STUDY SHOWED LOW DNA RATE AND LOW RATE OF
REFERRAL TO SECONDARY CARE
• PATIENTS WOULD BENEFIT FROM A MORE
EXTENSIVE INTEGRATION BETWEEN PRIMARY AND
SECONDARY CARE

16. COMMUNITY SURGERY
GMS DOES NOTE RECOGNISE THIS SERVICE IN
PRIMARY CARE
CURRENTLY PAID 25 EUROS BY THE HSE
INSURANCE PROVIDERS PAY APPROX. 133 EUROS
NO FACILITY FEE PAID

17. COMMUNITY SURGERY
• COST OF A PUBLIC PATIENT IN PUBLIC HOSPITAL IS
1480 EUROS (FACILITY FEE 700 EUROS)
• COST IN PRIMARY CARE CENTRE 510 EUROS (350
EURO FACILITY FEE)
• LOOKED AT 500 OUTPATIENT VISITS TO PUBLIC
HOSPITAL -250 PROCEDURES SAVING OF 970 PER
PATIENT
• GMS DOES NOT RECOGNISE GP’S CAN DELIVER THIS

18. COMMUNITY SURGERY
• THE PCSA ESTIMATE GP’S CAN WORK FOR AT LEAST
ONE THIRD LESS
• HUNDREDS OF GPS – READY TO GO
• PRIVATE INSURANCE COMPANIES WILL PAY THE
HOSPITALS A FACILITY FEE
• NO FACILITY FEE FOR GP’S --MOLE REMOVAL IN GP
IS {135 EUROS V 800 EUROS PRIVTE HOSPITAL}

19. IUCD/ COIL COSTS
• UK 2013/2014 NHS TARIFFS: HOSPITAL COST
1285 EUROS
• IRISH HOSPITAL COST ESTIMATED AT 1720
EUROS
• GPS IN UK CURRENTLY PAID (ENHANCED
SERVICE)FITTING, FOLLOW UP AND REMOVAL OF
IUCD £113.71 ( €144}
• IN IRELAND GMS PAYS 66.79 EUROS

20. JOINT INJECTIONS
• NOT COVERD ON THE GMS
• SAVING PER PATIENT OF 394 EUROS
• 250 PROCEDURES WOULD SAVE APPROXIMATELY
98500 EUROS
• AGAIN FREES UP CAPACITY IN THE HOSPITALS

21. THE GP TEAM
• MORE FOCUS ON THE DEVELOPMENT OF THE GENERAL
PRACTICE TEAM
• GP AS EMPLOYERS- MORE COST EFFECTIVE
• DEVELOP THE ROLE OF THE PRACTICE NURSE AND
ADVANCED NURSE PRACTITIONER
• FLEXIBILITY OF ROLES – UP SKILLING OF RECEPTIONISTS
– PHLEBOTOMY ETC
• HEALTH CARE ASSISTANT – LUNG FUNCTION TESTS, ECGS
NEBULISERS, BLOOD RESULTS, BP MEASUREMENT,

22. CHRONIC DISEASE
ICGP SUBMISSION ON COST EFFECTIVENESS AND
EFFICENCY
PROVEN WITH HEART WATCH AND DIABETES
PROGRAMME
QUALITY IN PRACTICE READY TO GO
RESOURCES, RESOURCES , RESOURCES

23. WE ARE READY TO ENTER THE DEEP END