National Association of General Practitioners

Annual Meeting15th November 2014

James M Sheehan

Changing Times

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Blood Pressure Recording

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Anaesthesia

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Anaesthesia

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Imaging

1963: X-ray

2013: US CT MRI Nuclear Med PET CT PET MR DEXA, RIS, PACS &

digital technology, Angiography

Interventional Radiology

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Rate Of Change

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Jobs

Top ten jobs were not available ten years ago

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My perspective of a GP

Family Friend Single handed practice Worked from home Minimal overheads Same day service House calls Evening and Saturday surgeries

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Diagnostics used sparingly Consultants rarely used Fees reasonable Wife …… secretary, receptionist,

accountant and all else Letters handwritten Confidentiality absolute

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Consultant / GPrelationship

Direct Public and private patients equal A and E referral after discussion Availability 100%, phone number

in book Ability to identify patient with GP

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What's changed…

Informed patients Medicolegal costs Electronic Records Unnecessary visits/prescribing A/E overuse Consultant Referrals 1.5% to

28% Taxation

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What's Changed ….

Free service to many Increased demands Overheads Defensive medicine Patient safety Competence assessment Family demands Working wives/husbands

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Solutions

Affordable Healthcare Singapore Healthcare Lee Kuan Yew: “Free medical

services collided with the reality of medical behaviour”

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Peoples desire to achieve and succeed must never be compromised by an over generous state

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Develop a sense of responsibility for all aspects of life

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Co - Payments

Essential at every level

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Insurance plans that give first € coverage play a major role in increasing costs

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Provide price transparency by publishing costs

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Singapore white paper 1993

Promote good health Promote individual responsibility Ensure good basic services for all Engage competition and market

forces Intervene only when necessary

to keep costs down.

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Collaboration between Ministries

Housing: designed for ageing Water Food supply Waste disposal Road traffic Parks Tree planting Infrastructure: pavements

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Role of Outpatient Satellite Dispensaries

General Practitioner Care Immunisation Health promotion Health screening and early

detection Well women's programmes Nutrition advice school

programme Psychiatric counselling Dental care Pharmaceuticals

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X RAY Laboratory Home nursing Rehabilitation services Management of chronic disease

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Are Singapore principles working?

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Spend

Singapore 4% of G.D.P USA 16% Ireland 9%

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Annual Government spend is 1.5%

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Per capita spend on Health

USA $7000 SINGAPORE $2000 Ireland $3000

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Acute beds

Singapore 20:10,000 Ireland 30:10,000

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Looming Problems

Ageing Population No financial planning or provision

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Statistics of Ageing2014Over 65’s = 11% of the populationOver 65’s = 50% of the hospital beds2034Over 65’s = 22% of the populationOver 65’s = ??? 100% of the hospital beds Over 85 year olds occupy over

three times the number of beds annually.

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Degenerative Disease

Over 65 yrs., 2/3 population have at least one chronic disease

1/4 have two or more Demand for healthcare increases

by 6% annually, i.e. 24% in 4 years

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Conditions of Ageing

Our bodies are outliving our brains

Dementia and Parkinson's disease

Skeletal Disease Ophthalmic Conditions Cardiovascular

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Reform of GP Practice

Review entry requirements for training programme

New well equipped health centres, tax incentives

Direct referrals for diagnostics National Electronic Medical

Record Minimise hospital referrals

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Retain control of your patients Reform medical insurance Use cheap technology where

possible Text Messaging, Online Bookings Develop one to one relationship

with Consultants Manage chronic disease

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Optimise your time Importance of Flexibility Increase investment in primary

care, currently 2.5% of Budget

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Proton Beam Therapy

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Proton Beam

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It is not about doing more with less.

It is about doing it differently and innovatively.