Publication of Review of Governance and Accountability Mechanisms in the General Medical Services by Deloitte & Touche
The Tánaiste and Minister for Health and Children today released on the Department’s website the Deloitte & Touche Review of Governance and Accountability Mechanisms in the General Medical Service. The Review was commissioned by the Department of Health and Children in October 2002 with a view to analysing governance and accountability mechanisms in the General Medical Services Schemes, the respective roles of the Department, former Health Boards and the former GMS (Payments) Board in the operation of the Schemes, and issues relating to the increasing cost trends in the GMS generally.
The main conclusions of the Review centre around the lack of an overall governance and management structure for the GMS system, the lack of cohesion in responsibilities between the various bodies negotiating and operating the GMS Schemes and the need for a single funding source for all of the schemes administered by the GMS. The lack of adequate governance and accountability structures, and limited financial modelling and forecasting were also noted. The Review also pointed out that the Estimates provisions for the GMS in recent years have been inadequate having regard to the actual requirement.
The Review also points to the need for a fundamental review of the GMS Schemes, which would encompass expenditure, structures, operation and compatibility with the broader Health and Primary Care strategies. A number of specific aspects of the operation of the GMS scheme are also highlighted, including the need to address issues relating to GPs and Pharmacists, drugs prescribing issues and the operation of the Indicative Drugs Target Savings Scheme. Finally, the Review notes the urgent need to implement a National Client Index which would provide a unique client identifier and avoid issues of data integrity around the medical card database arising in the future.
Developments since completion of Review
Since the Review was completed a number of important reforms have taken place in the Health Sector to give effect to a number of its recommendations, as follows:
The establishment of the Health Service Executive on 1st January 2005 has given practical effect to the recommendations in relation to governance and financing of the GMS Schemes, through the creation of a unified management structure for the General Medical Services. All aspects of the management and operation of the Schemes will now be through the Primary, Community and Continuing Care and Shared Services directorates of the Executive.
Specific recommendations of Deloitte & Touche which are being advanced under the auspices of the HSE include:
- A programme to introduce a National Client Index
- A programme to standardise the business processes around the medical card scheme and to examine the ICT and technical requirements for the modernisation of this scheme. This will be also extended to the community drugs schemes.
The HSE will provide a unified structure to standardise these business processes and provide the necessary technical support structures. Both programmes are being led by a dedicated team of HSE officials under the auspices of the National Schemes Modernisation Group.
In response to the recommendations regarding the need for improved financial forecasting procedures for the GMS Schemes, the forecasting model has been adapted by the HSE Shared Services – Primary Care Reimbursement Service to allow for three-year forecasting.
In the light of the recommendations regarding the cost of the GMS, further detailed analysis is being carried out by the Department of Health & Children in conjunction with the Department of Finance, and with the assistance of the former GMS (Payments) Board (now the HSE Shared Services – Primary Care Reimbursement Service) to identify policy options for managing the unsustainable growth in expenditure recorded in the schemes
In addition, the then Minister for Health and Children in February 2004 established a National Drugs Prescribing Group to evaluate proposals in relation to the control of drugs costs contained in the Review and other reports (e.g. Brennan) to determine their feasibility and early delivery as part of the Health Reform agenda.
These exercises will form the basis for initiatives to control costs in the context of the overall health care strategy.
All aspects of the drug delivery system from the manufacturer to the patient are currently under review. This, along with the two reports mentioned above, will form an important ongoing input into the determination of policy priorities for the GMS Schemes, and for their cost-effective management by the HSE.
Finally, the recommendations of the Review in relation to the GMS Schemes informed the Tánaiste’s recent decision to extend medical card eligibility through the introduction of the new ‘Doctor visit’ card.