Despite the long shadow cast over general practice by FEMPI cuts, increased workloads and manpower issues, the 2018 ICGP Winter Meeting had an upbeat and positive mood, according to its Chair Dr Rukshan Goonewardena, Acting Director, Network of Establishing GPs.
“Despite the pressures of the job, there are many positive aspects to working in general practice,” Dr Goonewardena told the Medical Independent (MI). “We had a range of speakers discussing how to implement positive changes, such as in-practice communications, business and financial systems, clinical care and the physical environment.”
Approximately 200 GPs attended the meeting, which took place on Saturday, 17 November, in Athlone, Co Westmeath, under the theme of ‘Cultivating a Happy, Healthy Workplace’.
“At every meeting for the last few years we have been talking about the cuts, FEMPI and funding and while those issues are priorities for all GPs, amid the negativity that surrounds general practice, with the Government and contract, this meeting was a good opportunity to give GPs something positive to think about and hopefully help retain GPs and keep them in practice,” Dr Goonewardena said.
A key session at the meeting was titled ‘The Power of Positive Change in the Practice’.
“Self-care is important for GPs and we encouraged doctors to think about those issues too. To mind your patients, you also need to mind yourself and to provide good care; the practice needs to run well so we looked at all that,” Dr Goonewardena commented, adding that simple advice like GPs having their own GP, and staying hydrated, eating during the work day and ensuring to get some exercise and enjoy hobbies are all vital to ensuring a happy, healthy GP.
During this session, Dr Andrée Rochfort, Director of Quality Improvement and the Doctors Health in Practice Programme, pointed out how physician performance is being increasingly linked with wellness and lifestyle factors such as sleep deprivation and stress. She also noted that cognition deteriorates during hypoglycaemia and dehydration, so GPs need to take their own advice they give to patients on healthy lifestyles.
Overall, Dr Goonewardena said it was a very positive meeting. “The best part was the positive vibe from GPs there… it doesn’t change the fact that FEMPI and the lack of a new contract is frustrating GPs and is a huge burden, but the meeting was very successful.” He added that a founding member of the College spoke from the audience to say it was one of the best meetings they had ever attended.
Women’s health
Sexual and reproductive health was a key focus of this year’s meeting, with sessions on long-acting reversible contraceptives, sexually-transmitted diseases, and the College’s draft guidance for termination of pregnancy services, which is due to come into force in January.
Dr Mary Short, Director of the ICGP Women’s Health and Reproductive Health Programme, presented an overview of the education and training supports being developed to support the roll-out of the new service. The College’s clinical guidelines for termination of pregnancy in general practice are currently in the draft stages, while a fee structure was recently agreed between the Government and the IMO. Dr Goonewardena noted that while these services are completely new to Irish general practice, they have been in existence in other places, such as New Zealand and the UK for some time, so there is a lot of learning and transferrable expertise from these jurisdictions.
“There wasn’t any controversy there [during this session],” Dr Goonewardena said.
“People took on board what is being done with guidelines and there were questions about the fine details of the guidelines, but nothing very controversial at all. I think we have come a long way from a time when we couldn’t even talk about it [abortion], to a time when we can openly discuss the clinical guidelines.”
Positives
Dublin GP Dr Mark Murphy, former ICGP Chair of Communications but speaking in a personal capacity, also agreed that the meeting had a very upbeat tone, with constructive advice and engagement on solving issues in general practice. He said meeting fellow GPs and networking in a supportive environment like the Winter Meeting was uplifting and beneficial compared to the often toxic and divisive atmosphere online, which is currently prevalent across social media and GP forums, where general practice funding/working conditions and abortion are generating a lot of very negative and often personalised commentary. “There is often disproportional negativity on those forums but whenever GPs meet up in person, it is a lot easier to converse and reflect on the problems and shared solutions. That is absolutely the highlight for me of meetings such as this; meeting other GPs face-to-face,” Dr Murphy told MI.
He also praised the meeting’s “excellent and varied educational content” and said there had been good, robust debate during the session on nursing home care. “GPs in the room spoke about their commitment to providing high-quality healthcare to residents of the community and to keep them at home where possible, and if they are in residential centres, to provide regular care there. However, I think we all acknowledge that the State contract to provide that care is woefully and inadequately resourced. So there were major concerns about that… ”
He also praised the meeting’s sexually-transmitted infection (STI) update, and added that it is important that STI screening and case-finding is incorporated into the new GP contract, as the current contract was devised long before STIs became an acknowledged, significant public health issue.
Digital medicine
Aside from clinical updates on a wide variety of topics, including insomnia, ENT issues, head and neck cancer, suicide prevention, the latest European hypertension guidelines, managing teenage depression and anxiety, and end-of-life care, there was a topical presentation on ‘Digital Medicine: Hope or Hype?’ by medical technology expert Dr Paddy Barrett, Consultant Cardiologist, Blackrock Clinic. Speaking to this newspaper, Dr Barrett said “the area of digital medicine to a significant extent has been largely over-hyped on the basis of direct consumer products”.
“Within the architecture of digital medicine, there are a lot of unregulated and unvalidated tools and technologies going directly to consumers that don’t solve direct clinical needs and have not been rigorously tested the way most pharmaceutical therapies and clinical devices are, or regulated. Because of this, amid all the promises they can’t deliver on, there has been significant pushback from the clinical community, which I think is entirely appropriate. But embedded within that is a huge opportunity in how we can change care delivery and how patients interact with healthcare.”
He believes cardiology has made the biggest strides in digital medicine, “in a scientific, validated way”, giving the example of wireless blood pressure monitors and skin patch sensors that will replace cumbersome Holter monitors. “This opens up a lot of the cardiovascular diagnostics (including ECHO and ultrasound) that were traditionally reserved for the hospital settings and can now be done at point-of-care in the community. I think that is of particular advantage to GPs.”
He acknowledged that GPs have legitimate concerns about the misuse of digital medicine in delivering potentially unsafe and under-regulated healthcare services, ie, online GP consultations and prescriptions.
“Everything is a tool and the harm is when the tool is used incorrectly and the primary care population are concerned about the inappropriate use of that tool, which I think is entirely justified,” Dr Barrett said.
“But I think when you actually look at how telemedicine can be delivered in an appropriate sense, there is definite utility — it just has to be deployed in a clinically appropriate mechanism.”
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