Address by Minister of State at the Department of Health & Children, Dr Tom Moffatt TD, at the opening of the 17th Annual Conference of the Irish College of General Practitioners


I would like to thank the College for inviting me here tonight to open its 17th Annual Conference. I think the theme of the Conference “Towards Better Practice – Shifting the Balance” is one that is relevant to us all in both our professional and private lives. As I understand it, it is concerned with evaluating what we do, why we do it and how we do it. As such, it is focussed on asking serious questions of ourselves. In essence, reflection leading to change.

I propose to begin tonight by addressing that issue of change in a general sense before dealing with certain specific matters that I know are of immediate concern to those here at Conference.

Reflection and Change

The theme of shifting the balance and embracing change is especially relevant now with the new Health Strategy scheduled to be launched in the Summer accompanied by a related but distinct major review of general practice.

Of course, frequent reference is made to the need for change. The fact is that change is inevitable even if we do nothing to bring it about. However, such change is unstructured and random. Its outcomes: unpredictable and variable. It is wholly inconsistent with a properly managed and developed health service that places the emphasis on equity, accessiblilty and people centred quality patient care.

Ultimately, therefore we are required to plan change, to make it happen the way we want. That process works best where it is based on genuine partnership, recognition of reality and willingness to adapt in terms of processes and people. It is clear that the joint ICGP/IMO vision statement falls very much into this category.

ICGP/IMO Vision Statement

I do not intend to say too much, at this time, on the jointly prepared Vision Document in advance of its formal launch tomorrow. But I would certainly like to avail of the opportunity to congratulate both the College and the IMO on coming together and preparing such a thoughtful, comprehensive and imaginative document.

Having read it, it is hard to argue with the areas it identifies as the priorities for change. Areas such as: practice and service development; appropriate funding; education and training; greater involvement by practising GPs in the development of the health services; manpower issues, special requirements of rural general practice and quality assurance are all indisputably of great significance and must be addressed if general practice is to play its fullest possible role in the integrated health service of the future.

Indeed, the areas enumerated in the Vision Statement broadly mirror the areas identified by the Health Board CEOs in their wide-ranging examination of general practice which they completed late last year.

Following the CEOs’ review, the Government has given its approval to move the process of developing general practice forward through a major consultative programme. That will begin shortly and given the range of infrastructural issues to be resolved it is likely to last at least 12 months.

Both the CEOs Review and the joint ICGP/IMO Vision Statement will serve as the starting points for that exercise. The objective being to agree a new Blueprint Document for the future development of general practice. Accordingly, the importance of this opportunity cannot be overstated.

I fully accept that many will point out that it is always considerably easier to talk about change than it is to bring it about. Many here tonight are all too familiar with the current reality of increasing workloads, the demands of being on call 24 hours a day, the full surgery of concerned and, sometimes, impatient patients, the feeling of isolation from other healthcare sectors, the pressures of being a full time clinician as well as an employer and manager, the strains on family, the increasing levels of paperwork and form filling, the feelings of being under-appreciated and valued. But given that this is the reality for so many GPs, doesn’t it in itself make the case for embracing this opportunity for change?

I have to stress that the Government is fully committed to the present review process as it is to health services generally. The agreed blueprint will form the basis of a properly developed and resourced future general practice. The extent of the Government’s commitment to health care can be seen from the doubling of spending on healthcare from £2.5B in 1997 to £5B this year.

The College has been at the forefront of pressing for change since its inception. I look forward to the contribution it will make to the entire review exercise. It will bring its own distinct perspective. That can only be beneficial:- worthwhile policymaking is dependent upon serious debate and the positive reconciliation of different perspectives.

More specific matters

Turning now to more specific matters, I would like to refer briefly to the issue of medical cards eligibility for those aged 70 and over as announced in the December Budget. The issue has attracted quite a considerable degree of comment. I would like to make a few quick points which are intended to help put the matter into context. First, at the beginning of this year, there were just over 250,000 person aged 70 and over with medical cards – that is 89% of the total population of persons in that age category. Second, the final phase of the three-year programme of doubling income limits for the elderly brought another 12,000 persons into the medical card scheme in March. That means that only around 33,000 persons are left to benefit from the Budget provision. When that figure is spread over the number of relevant GPs it works out at less than 20 per GP. That statistical exercise is not meant to trivialise either the issue or the feelings of GPs on the subject but rather to try and put some perspective on the likely average impact for GPs of the measure.

I would also add that the Budget announcement on medical cards is fully in keeping with the Government’s overall commitment to improving as far as possible the position of our elderly. As Minister with special responsibility for the elderly, I cannot but welcome such initiatives. It is also worth pointing out that the Budget measure was not at the expense of any other group in society.

In that regard, there is a Medical Card Eligibility Review, established under the PPF, currently being carried out by the Health Board CEOs which is examining the whole area of medical card eligibility. Particular emphasis is being placed on removing anomalies as well as on the needs of families with children and on barriers to take-up, including information deficits. Consultations with representatives of the social partners and relevant Government Departments are taking place as part of the review. I understand that the review is expected towards the end of the year.

In addition, the whole question of eligibility is being examined as part of the new Health Strategy currently being prepared.

I welcome the fact that talks are scheduled to take place very shortly on the implementation of the Budget measure and those talks will provide a forum for all the relevant issues of concern to GPs on this matter to be addressed.

Recent Agreement with the IMO on GP Matters

In that context, I am glad that a recent agreement has been concluded at the Health Service Employers’ Agency on a range of other matters of interest to GPs, including the Primary Childhood Immunisation Scheme and a range of GMS Scheme matters, including discretionary medical cards, asylum seekers, practice nurse and secretaries’ grants. All of these matters are important to the GP in his or her surgery.


In a more general sense, they show that the resolution machinery works and, more importantly, they send out the clear signal that the Government and the Department of Health and Children are committed to resolving issues of concern to GPs in a practical way.

The development of well resourced out of hours GP models is another example of where the Government is putting resources into general practice that benefits not just patients but also GPs. The development of further out of hours models alongside those already in place in Carlow and throughout the North Eastern Health Board regions will be progressed after the existing pilot models have been evaluated. That evaluation is now ongoing. There is also the role that general practice is playing in the implementation of the CardioVascular Strategy and in several other areas where its expertise is being utilised to increasingly positive effect, in particular in the areas of health promotion.

Such initiatives are important in terms of the wider strategic challenges lying ahead. It all goes to helping to build confidence and trust between GPs, policy makers and administrators at this critical time where the entire future shape of general practice is about to be determined.

As the French novelist and philosopher Victor Hugo said: “Nothing is as powerful as an idea whose time has finally come”. For general practice, the time is now and I wish the Conference every success in its important work.