The European Junior Doctors (EJD) and the Irish Medical Organisation (IMO) held a joint seminar on GP Training Issues on Saturday 5th of September in IMO House.
The Irish GP and GP Training System
The seminar began with a presentation from Dr Rukshan Goonewardena of the IMO NCHD Committee and Former Chair of the National Association of GP Trainees. Dr Goonewardena highlighted the survey from the Medical Council which highlighted that trainees in General Practice generally reported better experience of training than those training in mental health services or within larger and smaller hospitals. Despite general satisfaction with training there were issues with training time, funding of trainee schemes and general uncertainty about the future of general practice. Dr Goonewardena also highlighted that 33% of GPs are over 55 years old and due to retire in the next 10-15 years, difficulties in filling rural GP posts and that many GPs and indications that many young GPs are considering going abroad when they complete their training.
What do GPs in Europe do?
Dr Monica Teran Gomez then presented research by Dr Mary McCarthy at the European Union of General Practitioners (UEMO) which shows that while training length is similar across Europe, work load varies both across and within European countries. In some countries whether by law or by custom family doctors do not treat children. In all European countries GPs in rural areas tend to take on greater responsibilities for patient care due to lack of resources and difficulties accessing specialist care.
Chronic Disease Management in Reality
Chronic disease management programmes are being developed across Europe. Dr Anna-Eva Speeks, President of LOVAH of the Netherland presented the Dutch programme for Cardio-vascular risk management while Dr Carsten Morhardt, President of the EJD presented the German programme for managing Asthma and COPD. Lessons from the German example suggest that the administrative burden can overshadow the focus on individual patient care.
Clusters and Assessments – a New Approach in Hungary
Dr Gergely Furjes, Chief Deputy Professional Leader, National Institue for Primary Care presented a pilot project of GP clusters in Hungary which was launched in 2012 to restructure primary care and improve health services provided by GPs and other healthcare professionals in disadvantaged regions. One core element of this new system is the health assessment of the population in the intervention area to determine the health status of the individuals. This successful project involving up to 6 GPs, a public health coordinator, a team of allied health pratitioners and local volunteers is improving health and reducing the risk of long-term health problems in some of the most diasadvantaged, rural areas of Hungary.
How eHealth Improves Primary Care
After the lunch break, Dr Raquel Gomez Bravo of the Vasco de Gama Movement presented how eHealth has the potential to improve both interactions between doctors and patients as well as the transfer of information between general practice and the hospital setting. 93% of practices across Europe have some basic form of electronic health records, but barriers exist to wider use of eHealth with concerns about interoperability and issues of confidentiality and privacy. There is a need for GPs to take ownership of the digital health agenda.
Training in Practice Management
Few countries emphasise practice management and leadership in GP training courses. Dr Speeks discussed how in the Netherlands they are attempting to bring in training in medical leadership across specialisations.
Summing up Dr Ray Walley, President IMO and Dr Carsten Morhardt, President of the EJD stressed the importance of General Practice in treating the majority (95%) of illnesses and providing personalised continuity of care. Issues of an ageing population and an ageing GP population are not unique to Ireland. More focus needs to be placed on the value for money provided in primary care and the gatekeeper role.