Bord Snip Nua Report (Competition with GMS)

bleg

370m to be saved on GMS and LTI affecting GPs, Dentists and Pharmacists.

H.4 Invite tenders by open competition to provide service under the GMS
Any reduction in eligibility coverage will have implications for the income of service providers
(GPs, pharmacists, dentists and opticians). There are some 5,700 such health care service providers
and these are generally remunerated through a contract encompassing a fees framework essentially
based, as appropriate, on capitation rates or fee per item dispensed. Furthermore, the medical
professional representative bodies have been successful at restricting entry to professional practice
- 139 -
(although there has been some limited progress in terms of increasing access to medical education
in recent years, including the introduction of graduate entry to medical schools). The representative
bodies enjoy a veto-like power over the introduction of new services or expansion of existing
services, even though the contracts are based on commercial agreements with individual
undertakings. The existing contracts favour the supplier more than the purchaser. The Special
Group notes that the Competition Authority is expected to finalise its report on General Practitioners
by the end of 2009.
It also notes that the Minister for Health & Children now has the power under the Financial
Emergency Contributions in the Public Interest Act 2009 to determine payments to health
professionals by regulation following a 30-day consultation process.
The Group recommends that the HSE phase out existing contracts with GPs and pharmacists as
quickly as possible and fashion their own specific contracts enabling the HSE to specify the
services they require and to set a price acceptable and affordable in the light of the dramatically
changed budgetary situation as well as enabling suppliers to compete to provide these services. The
Group anticipates that, properly structured, savings of up to €370m could be achieved from such an
approach.

anotherlostie

I'm not really sure what they mean here. It reminds me of Sir Humphrey speak in Yes, Minister. Is it suggesting that an alternate body tender run the system, or that the GMS squeeze everyone using the system (like reducing mark up for pharmacists on DPS scripts???), or that fewer people be eligible for services? And no mention of reducing the costs of buying drugs from pharma manufacturers despite all their work.

bleg

My understanding of it is that GPs and pharmacists will have to compete for the contracts to provide GMS care by cutting the amount they charge in fees. Therefore groups of GPs in a practice or a chain of pharmacies will be able to undercut their independent candidates. not exactly crystal clear though.

RobFowl

bleg wrote: »

My understanding of it is that GPs and pharmacists will have to compete for the contracts to provide GMS care by cutting the amount they charge in fees. Therefore groups of GPs in a practice or a chain of pharmacies will be able to undercut their independent candidates. not exactly crystal clear though.

My understanding completely (bias as am a GP). It would effectively remove a GMS patines ability to choose their doctor, also continuity of care would be destroyed as tenders by EU law have to be resubmited every 3 years at least. SO a 70 years old who has had the same GP for 30 years could be shunted from one low cost provider to another evry 1-3 years .
Good thinking Colm Mccarthy

jeepers

RobFowl wrote: »

My understanding completely (bias as am a GP). It would effectively remove a GMS patines ability to choose their doctor, also continuity of care would be destroyed as tenders by EU law have to be resubmited every 3 years at least. SO a 70 years old who has had the same GP for 30 years could be shunted from one low cost provider to another evry 1-3 years .
Good thinking Colm Mccarthy

I don't think continuity of care will be a major issue as the winners of the inital tender will most likely win subsequent tenders. The inital winners (especially in built up areas) will most likely be amalgamtions of GPs per area. A low cost, increased patient-per-hour model will emerge with a high cost barrier-to-entry for new players. Complete monopolies will appear especially in high GMS low private business areas as anyone not on the inside from the beginning is out of business/gone from the area.

Independent pharmacy will die a quick death at the hands of Tescos and Boots.

anotherlostie

I can just see mega-GP centres springing up in every urban centre in the country so, and I'm sure an Bord Snip won't consider how those without transport will be able to make their way to these, given that doubtless they will be located on cheap out of town land. Fine if you're driving, but what if you're not? And will Irish qualified GP's be happy to work as yellow packers, or will they follow the nurses out of the country in search of a better wage?

RobFowl

jeepers wrote: »

I don't think continuity of care will be a major issue as the winners of the inital tender will most likely win subsequent tenders.

SR technics ! They won the tender for aer lingus 12 years then lost it
High volume low cost operators will move in and out as soon as margins get too tight. Also inner city and difficult areas will simply be left with no bidders.
The cost may initially go down but will eventually creep back upwards as any competition is eliminated.

irish_bob

anotherlostie wrote: »

I can just see mega-GP centres springing up in every urban centre in the country so, and I'm sure an Bord Snip won't consider how those without transport will be able to make their way to these, given that doubtless they will be located on cheap out of town land. Fine if you're driving, but what if you're not? And will Irish qualified GP's be happy to work as yellow packers, or will they follow the nurses out of the country in search of a better wage?

and where might nurses recieve a better wage

anotherlostie

irish_bob wrote: »

and where might nurses recieve a better wage

Examples might be the USA and the various gulf states like Dubai and the UAE. Anyway, that is not what this thread is about.

Vorsprung

Doctors don't tend to leave Ireland for the wage, it's more for training and experience in larger centres which would see a larger range of cases. The training system is a bit ****e in Ireland as well, that's part of the reason I'm heading off for a while anyway.

anotherlostie

Vorsprung wrote: »

Doctors don't tend to leave Ireland for the wage, it's more for training and experience in larger centres which would see a larger range of cases. The training system is a bit ****e in Ireland as well, that's part of the reason I'm heading off for a while anyway.

I know that's the case with hospital docs(and my OH is one of those away learning, for 2 years now:( ), but didn't know it was also the case with GP's. My suggestion is that if general practice in Ireland develops into a Tesco model with cheapest delivery winning the contracts, isn't it possible that Irish qualified doctors will choose to leave rather than work as GP's in such a system?

Traumadoc

I think that it will be a seismic change. Health centers will open up in Supermarkets ( I believe this is happening already) more overseas trained doctors will be invited in ( as happens with many out of hours deputising services already). Not sure if this is a good or bad thing.

However it may mean better access to services such as community based radiology and pathology.

More in the mould of the funding following the patient. Which seems to be the new flavour of the month for the HSE.

RobFowl

anotherlostie wrote: »

I know that's the case with hospital docs(and my OH is one of those away learning, for 2 years now:( ), but didn't know it was also the case with GP's. My suggestion is that if general practice in Ireland develops into a Tesco model with cheapest delivery winning the contracts, isn't it possible that Irish qualified doctors will choose to leave rather than work as GP's in such a system?

It's very possible and at least 3 of my peers have done so in the last year

nesf

Ok my issue as an economist is this: is a "resource inefficient" model based around single GP clinics desirable? Surely with the situation of the public purse at least, pursuing the system that manages the most care at the least cost is what we should look at? Continuity of care is important but so is healthcare cost, our population's average age is only going in one direction and by the time those of us in our late twenties and early thirties are retiring there will be far fewer workers to support those 70 year old pensioners so implementing a more cost effective system early and working the kinks out now when we've got time makes sense. It cannot degenerate into a Tesco style bargain basement deal because it's just not that kind of market. At GP level treatment is tailored and complex, patient history plays a huge role in patient outcomes and any move to a system where this isn't taken into account will result in a very obvious turn in the results of patient outcomes which will put pressure on politicians etc.

As a patient, I like my present GP and wouldn't like to move but fortunately long term mental health issues don't qualify one for a medical card or any other support so I've the luxury of paying my GP out of my own pocket and can go to whoever I like.