National Association of General Practitioners Annual Meeting 15 th November 2014 James M Sheehan.
-
Upload
oswald-gilbert -
Category
Documents
-
view
213 -
download
0
Transcript of National Association of General Practitioners Annual Meeting 15 th November 2014 James M Sheehan.
National Association of General Practitioners
Annual Meeting15th November 2014
James M Sheehan
Changing Times
Slide 3
Slide 4
Blood Pressure Recording
Slide 5
Anaesthesia
Slide 6
Anaesthesia
Slide 7
Slide 8
Slide 9
Slide 10
Slide 11
Imaging
1963: X-ray
2013: US CT MRI Nuclear Med PET CT PET MR DEXA, RIS, PACS &
digital technology, Angiography
Interventional Radiology
Slide 12
Slide 13
Slide 14
Slide 15
Rate Of Change
Slide 16
Jobs
Top ten jobs were not available ten years ago
Slide 17
My perspective of a GP
Family Friend Single handed practice Worked from home Minimal overheads Same day service House calls Evening and Saturday surgeries
Slide 18
…….
Diagnostics used sparingly Consultants rarely used Fees reasonable Wife …… secretary, receptionist,
accountant and all else Letters handwritten Confidentiality absolute
Slide 19
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
Slide 20
What's changed…
Informed patients Medicolegal costs Electronic Records Unnecessary visits/prescribing A/E overuse Consultant Referrals 1.5% to
28% Taxation
Slide 21
What's Changed ….
Free service to many Increased demands Overheads Defensive medicine Patient safety Competence assessment Family demands Working wives/husbands
Slide 22
Solutions
Affordable Healthcare Singapore Healthcare Lee Kuan Yew: “Free medical
services collided with the reality of medical behaviour”
Slide 23
Peoples desire to achieve and succeed must never be compromised by an over generous state
Slide 24
Develop a sense of responsibility for all aspects of life
Slide 25
Co - Payments
Essential at every level
Slide 26
Insurance plans that give first € coverage play a major role in increasing costs
Slide 27
Provide price transparency by publishing costs
Slide 28
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.
Slide 29
Collaboration between Ministries
Housing: designed for ageing Water Food supply Waste disposal Road traffic Parks Tree planting Infrastructure: pavements
Slide 30
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
Slide 31
X RAY Laboratory Home nursing Rehabilitation services Management of chronic disease
Slide 32
Are Singapore principles working?
Slide 33
Spend
Singapore 4% of G.D.P USA 16% Ireland 9%
Slide 34
Annual Government spend is 1.5%
Slide 35
Per capita spend on Health
USA $7000 SINGAPORE $2000 Ireland $3000
Slide 36
Acute beds
Singapore 20:10,000 Ireland 30:10,000
Slide 37
Looming Problems
Ageing Population No financial planning or provision
Slide 38
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.
Slide 39
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
Slide 40
Conditions of Ageing
Our bodies are outliving our brains
Dementia and Parkinson's disease
Skeletal Disease Ophthalmic Conditions Cardiovascular
Slide 41
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
Slide 42
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
Slide 43
Optimise your time Importance of Flexibility Increase investment in primary
care, currently 2.5% of Budget
Slide 44
Slide 45
Slide 46
Proton Beam Therapy
Slide 47
Proton Beam
Slide 48
It is not about doing more with less.
It is about doing it differently and innovatively.