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‘House’ doctor move disputed by ICGP and HIQA

04 Aug 2015

A recommendation in the Government review of a Fair Deal scheme, that nursing homes should consider offering access to a ‘house’ doctor in each facility, would pose difficulties in rural settings, the ICGP has told Irish Medical Times.

Published by the Department of Health last week, the review of the Nursing Home Support Scheme (NHSS) said that while HIQA guidance was that residents may choose to retain their own GP on admission to a nursing home, there was “a strong case for requiring nursing homes to offer access to a ‘house’ doctor in each facility”.

“This would facilitate the development of effective channels of communication and good working relationships between the GP and the nursing home staff, which would only be of benefit to residents,” the review stated.

However, Chair of Communications at the ICGP Dr Mark Murphy told IMT that while a ‘house doctor’ might seem sensible for a very large nursing home, it may not be practical for many smaller nursing homes, particularly those in rural areas.

“In rural Ireland, local GPs continue to care for their patients in the local nursing homes in the area. At a time when there are serious shortfalls in the capacity of general practice — with too few GPs being trained, many GPs leaving Ireland and a paucity of GPs in the country — the ability of such a policy to be realised and its effects on general practice capacity would need to be considered,” Dr Murphy stated.

Commenting in general on the report, Dr Murphy said it was clear from the review that many older people would prefer additional supports in the community to enable them to remain living either at home or in adapted accommodation for longer, and health policy should reflect this preference.

“The ICGP believes that beneficiaries of the NHSS should be able to choose between community supports or longer-term residential options where this is appropriate. In July 2015, a motion was proposed by Dr Richard Brennan, ICGP Board member, and subsequently passed at an ICGP Board meeting, stating that the ICGP would advocate for the provision of community supports so that senior citizens can remain for the longest possible time living independently in their communities. It is an opportunity lost that prioritising the resourcing and regulation of home care is not dealt with in more detail in this review of the NHSS,” he said.

Responding to the suggestion of appointing a house doctor in each nursing home, HIQA told IMT that the Health Act 2007 required that the person in charge should, in so far as was reasonably practical, make available to a resident a medical practitioner chosen by or acceptable to that resident.

“HIQA believes that the human rights of all our citizens should be protected and this should include those in receipt of long-term residential care. People living in residential care should have access to and be entitled to the same services that older people living in the wider community are entitled to, and that this should include choice in respect of primary care medical services and, where necessary, the requirement for specialist medical services should be organised through established referral systems.”

The IMO told IMT that the GP’s relationship with the patient was governed by the GMS contract. “In circumstances where a service which is not part of the GMS contract is required then a separate arrangement beyond the contract should be entered into between the nursing home and the GP.

“There is currently no contractual relationship between the nursing home and the GP and as such a formalisation of this relationship would be beneficial to the patient and may resource the GP to provide the service required.”

By June Shannon

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Click here to view the full article which appeared in Irish Medical Times