FEMPI has had a devastating effect on general practice, leaving in its wake a legacy of unviability, overwhelming negativity and an environment that newly qualified GPs found hostile and unable to commit to. 

The recent agreement between IMO and the Department of Health/HSE should begin to create a sense of security which enables doctors to commit to a future in the specialty and recognise it as a vital cog in the health service. This deal has resulted in agreement for the unwinding of FEMPI and securing resources necessary for the stabilisation of general practice.

Agreement has been reached to implement some far reaching e-health measures that will have a significant effect on the modernisation of practice and will bring benefit to both patients and doctors.

It introduces a new working relationship between GPs and other health professionals through the Community Healthcare Networks, benefitting all and giving GPs a say in how local services are best deployed.

The agreement provides for chronic disease management for patients in a structured way in the community, and importantly, creates the principle that additional workload requires additional funding.

The GP deal, while completed in recent weeks, had its genesis some years back and came about as a result of measures the IMO undertook, starting with the securing of GP negotiating rights under a Framework Agreement in 2014.  Prior to this, the Department of Health and HSE refused to engage with general practice for eight years – using their interpretation of the Competition Act to effectively lock out  general practice.

As part of the settlement, following a hard-fought legal case, the Framework Agreement allowed the IMO to negotiate terms and conditions for its members in any public contract or agreement. This resulted in the IMO being enabled to negotiate many agreements relating to general practice in recent years.

Also in 2014, the IMO recognised the need to further the agenda of chronic disease management in general practice. Many were providing this service in an ad-hoc and unstructured manner with no targeted resources. 

Structured chronic care has been shown to have significant health benefits, as evidenced by the recent audit results arising from the Midlands Structured Care Diabetes Programme, spearheaded by Velma Harkins for the past 20 years, and the IMO set about to convince the Department and HSE that this was the appropriate direction to pursue. A presentation in Buswell’s Hotel in October 2014 attended by many of the key stakeholders laid bare the inevitability of capacity crisis and financial ruin in the health service should this path not be followed. This message hit home with some of the key stakeholders, in particular the HSE, which sought engagement. The IMO always caveated such discussions that FEMPI reversal had to be addressed first.

In 2015, preliminary discussions took place, with exchanges of positions on a variety of issues, and significant detail was developed which was to lay the foundation for the eventual agreement. 

There was a steady stream of talks through 2017 but as the Budget estimates emerged that year it became clear that the provision of e25 million for primary care in 2018 went no way towards  serious intent. The IMO suspended talks, advising the Department that re-engagement would not take place unless there was a serious financial commitment (ringfenced) and available for both reversal of FEMPI and provision of funds for new services. In January 2018 further exploratory meetings took place, outlining the same position, no FEMPI – no chronic disease management.

In the months following, intensive lobbying took place with politicians and the Minister for Health announced at the IMO AGM last year that talks would commence to move to a “post-FEMPI” era. Those talks commenced but it was with some shock that we again found ourselves in the position that the Department/HSE was effectively seeking to bring in new contractual terms and new services using the FEMPI monies. Difficult as it was, the IMO decided it could not  engage in such negotiations. We insisted FEMPI must be restored, albeit with some productivity provisions, to underpin existing services, and new monies were needed for any new services.  

Towards the latter half of 2018 we were advised that the Government position recognised that additional funds were required and ring-fenced funding would be pledged to allow negotiations to commence. Intensive talks took place between October and December to see if there were grounds for the continuation of negotiations, and further rounds of intense negotiations recommenced in January, stretching to a total of over 50 full working days in the latter stages, culminating in agreement last month.

The IMO views this deal as the start, not the end. There are other issues that need to be addressed – women’s health, nursing homes, out-of-hours etc. This was never going to be a negotiation of a new contract – there were never the resources available to do so, and increased capacity and resources are required before this can be achieved. A new contract needs to be developed incrementally.