WHAT DOES THE FUTURE HOLD FOR GENERAL PRACTICE?

WHAT DOES THE FUTURE HOLD FOR GENERAL PRACTICE?
By Dr Liam Twomey. T.D.

RADICAL changes in work practices are definitely on the cards.

For instance, let's take a look at the following:

Information technology will be the most significant change to our lives in the next ten years. Interlinkage between primary and secondary care will become the norm. The GP surgery will link up with the laboratory and the hospital outpatients to make the exchange of information much faster and easier. Unfortunately, the software packages that are available in primary care are not even compatible. The hospitals and the health board also have imcompatible software packages. This problem must be overcome. We have already wasted enough money on this problem, but it must be sorted out before we can move further on.
The out of hours issue will be resolved out of necessity, not out of concern for the doctors, but in order to provide some form of GP out of hours cover. The present system of rotas will not be adequate because there will not be enough doctors to provide this type of cover in years to come.
There will be reorganization of the GPs working day. First of all, we will see more nurses moving into primary care to join the 700 of 800 already there. They will take up primary responsibility for doing bloods, immunization, smear and preventative health. We will see an increase in practice managers in larger practices, but even in smaller practices, secretaries will start taking over more of the administrative work.

Why will this happen? Quite simply, there will not be enough doctors in the system and we will have to work out a better use of our resources. This may give some GPs the impression that all we will be doing in years to come is doctoring, but there is another vital component to general practice and that is managing general practice services.

General practice is not an island; we are subjected to huge outside influences. There will be:

A) increased patient expectations, both old and young patients will be attending the surgery more often and they will be expecting more from consultations than they do at present.

B) The Health Boards will look for more administration of general practice. They are anxious to glean all that epidemiological data that is available in our surgeries. In some respects, that is the reasoning behind computerization of general practice.

C) The Department of Health is looking for control of general practice. They are not too happy with the independent contractor status that we hold at present. You only have to look at the hospital consultant contract to see the clause, which specifies that they cannot speak out against the health service without getting clearance from the CEO.

D) Sadly, most politicians have little knowledge of how the health service really works. They use it mainly to provide sound bites for their own agenda.

E) The media is a double-edged sword. It is a very efficient and effective way of getting your viewpoint across; the difficult part is getting the access. It may also work against you. If any doctor makes a mistake, trying to use the excuse that you are overworked or had been on call for the previous 48 hours will cut no ice with anyone.

Some of the difficulties that we face in the future are of our own making, but it has more to do with being too good than being bad. We are one of the last remaining 'sacred cows'. The clerical abuse scandals of recent years have very much damaged the reputation of the church. The mishandling of pay claims by teachers has done no good to their position in Irish society.

The question has to be asked: what gives us such a good standing with the people of Ireland? A number of things:

We get consistently good patient satisfaction ratings in all surveys;
We give good value for money; this was alluded to in the Deloitte and Touche report commissioned for the Government. This will also be the basis of some of our future problems.
We are managing a huge workload; we are doing 90% of the work for 10% of the funding.

We have remained untouchable up to now because of the sacrifices our peers made and because we are still willing to work hard for a remuneration that is below our market value.

Overall, the general public does not realize how much work is done by GPs. One thing they are used to, however, is excellent service and they will not tolerate a deterioration to this service.

I have mentioned some of the changes that I expect, but there are negative aspects developing in general practice:

The decreasing manpower availability is the most pressing.
Primary care needs more resources. Basically put, this is money. But we can expect to hear the usual buzzwords such as audit, transparency and VFM - 'words they would never apply to themselves'.
GPs are no longer willing to sacrifice their family or their social lives; this agenda was started by young female GPs, but has quickly been taken up by all GPs. This has led to a positive benefit to general practice, but I want to make an unpopular comment there…be careful how far we take it!

There are others willing to take over any responsibility for general practice that we give up. In the short term, it might sound nice to make someone else responsible for general practice issues. Many young members of the profession do not get involved in medical political issues. They like to say their family and their own quality of life is more important. But remember who is out there to take over where you are letting off. It is the politician and the health boards and their agenda is not the same as yours, most of the time.

Politicians are much better and much more resourceful at public relations than doctors. When the service deteriorates - and I know it will - it will be easier to point a finger at a recognizable face (the local GP) than a faceless bureaucrat in the health board, or the Department of Health. That is why we must remain vigilant as to how general practice develops.

In conclusion, our peers and those who came before us, set very high standards for us to uphold. Older GPs gave their lives to general practice, something we are not willing to do.

Changes in work practices, such as information technology, co-ops, or even the proposed primary care centers are issues that we will quickly adapt to. General practice has always been evolving and we are used to responding to both our patients' expectations and to the market realities.

What worries me is our compliancy to the responsibility for who controls this evolving process. For the sake of our patients and ourselves, we must remain in charge of this evolving process. In ten years time we might be calling it primary care; but remember the person responsible when things go wrong. It is the person in charge.

You owe that to your patients.

Visitors

	Ireland's Association of General Practitioners