Terms of Reference for a Strategic Review of General Practice

The government has previously set out its intention to undertake a strategic review of the contractual framework for GP services in the context of implementing Sláintecare. The 2019 Agreement on Contractual Reform and Service Development between the Department of Health, the HSE and the IMO includes the following commitment:

The Department of Health, with the support of the HSE, will undertake this review and will engage with key stakeholders to identify the challenges facing general practice in ensuring the delivery of a sustainable general practice service within the community and to identify the measures necessary to address those challenges in the context of delivering on the principles of Sláintecare. The review work will be led by a Department of Health Review Project Group supported as necessary by external expertise. Its programme of work will be supported by a Review Steering Group supported by and with input from external GP expertise. To support the review process the HSE GP Oversight group co-chaired by the Chief Operations Officer and Chief Clinical Officer will be the mechanism for the coordinated agreed input from the HSE to enable referral of issues from and input to the process. Responsibility for the output report and its submission to the Minister rests with the Department of Health.

A. Department of Health Review Project Group

1. Agree and progress a structured programme of ongoing consultative engagements between the Review Project Group and/or the department and the HSE with key sectoral stakeholders to:

• further explore and define the issues, listen to stakeholder views and identify potential approaches to respond to the issues;
• gather information, evidence and data as required from stakeholders to inform the work of the Group;

2. Direct the collection and analysis of required data and information, including demand and capacity projections;

3. Prepare thematic discussion papers to support the work of the group as appropriate; 4) Use available evidence to inform the review and in particular examine the following:

GP Training

• ensure an adequate supply of general practitioners to meet the changing needs of the population, and identify measures to address retention of GP graduates at every stage of their career;

GP Capacity

• expand the GP team to ensure efficient and effective service delivery with all members of the team working as closely to the top of their licence as possible, with particular focus on: the role of GP nursing; administrative support for practices; and consideration of the value of the development of other potential roles that would improve service delivery while taking account of the development of wider community services through the Enhanced Community Care Programme;
• ensure service provision within the community, focussing in particular in areas where service delivery is challenging – this will include consideration of the possible role of HSE-employed GPs and other mechanisms to attract GPs to rural and urban deprived areas;
• maximise available and future GP capacity, including panel sizes;
• provide for practice establishment and succession planning;
• integrate and interface with wider health services including the Enhanced Community Care Programme;

eHealth Agenda

• identify the requirements, including supports to provide necessary infrastructure and IT and consideration of potential approaches of existing and future practices to provide a sustainable GP service in the community;

Out of Hours Reform

• identify the requirements necessary to reform of Out of Hours GP services to ensure delivery of an accessible, high quality Out of Hours GP service throughout the country;

Support model

• consider the scope of service to be provided to patients on a universal basis;
• develop the support model necessary to underpin the provision of sustainable GP services in the Sláintecare vision; and
• examine the tax treatment of practices and identify barriers and potential enablers to support enhancement of capacity

5.Prepare recommendations as appropriate and associated indicative costings;

6. Within 6 months, develop a report for the consideration of the Minister for Health providing:

• an outline of the key findings on a thematic basis;
• recommended actions to respond to the identified findings, as appropriate, including indicative costs and a proposed response plan

B. Strategic Review Steering Group

The Review and the Review Project Group will be supported by a Review Steering Group which will include the department, the HSE and GP expertise, which will:

1. provide direction, guidance and support to the Project Group in examining these issues;

2. agree the broad programme of work proposed by the Project Group;

3.review and provide input, including expert advice, into discussion papers and other outputs prepared by the Review Group;

4. facilitate national and/or international expert input to inform the work of the Group;

5. support the referral of issues to and/or input from the HSE GP Review Oversight Group;

6. advise, assist and provide input to the department Review and recommendations prior to its finalisation by the department

The review process will undertake a structured programme of engagements with key sectoral stakeholders in line with their respective roles and responsibilities. The Review Project Group may also request written submissions on specific themes, as relevant, from stakeholders.

A Department of Health report of the findings of the strategic review will be developed for submission to the Minister within 6 months, providing:

• an outline of the key findings on a thematic basis
• recommended actions to respond to the identified findings, as appropriate, including indicative costs and a proposed response plan