1. National Association of General Practitioners Annual Meeting 15 th November 2014 James M Sheehan

2. Changing Times

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4. Slide 4 Blood Pressure Recording

5. Slide 5 Anaesthesia

6. Slide 6 Anaesthesia

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11. Slide 11 Imaging 1963: X-ray X-ray 2013: US US CT CT MRI MRI Nuclear Med Nuclear Med PET CT PET CT PET MR PET MR DEXA, RIS, PACS & digital technology, Angiography DEXA, RIS, PACS & digital technology, Angiography Interventional Radiology Interventional Radiology

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15. Slide 15 Rate Of Change

16. Slide 16 Jobs Top ten jobs were not available ten years ago Top ten jobs were not available ten years ago

17. Slide 17 My perspective of a GP Family Friend Family Friend Single handed practice Single handed practice Worked from home Worked from home Minimal overheads Minimal overheads Same day service Same day service House calls House calls Evening and Saturday surgeries Evening and Saturday surgeries

18. Slide 18 ……. Diagnostics used sparingly Diagnostics used sparingly Consultants rarely used Consultants rarely used Fees reasonable Fees reasonable Wife …… secretary, receptionist, accountant and all else Wife …… secretary, receptionist, accountant and all else Letters handwritten Letters handwritten Confidentiality absolute Confidentiality absolute

19. Slide 19 Consultant / GP relationship Direct Direct Public and private patients equal Public and private patients equal A and E referral after discussion A and E referral after discussion Availability 100%, phone number in book Availability 100%, phone number in book Ability to identify patient with GP Ability to identify patient with GP

20. Slide 20 What's changed… Informed patients Informed patients Medicolegal costs Medicolegal costs Electronic Records Electronic Records Unnecessary visits/prescribing Unnecessary visits/prescribing A/E overuse A/E overuse Consultant Referrals 1.5% to 28% Consultant Referrals 1.5% to 28% Taxation Taxation

21. Slide 21 What's Changed …. Free service to many Free service to many Increased demands Increased demands Overheads Overheads Defensive medicine Defensive medicine Patient safety Patient safety Competence assessment Competence assessment Family demands Family demands Working wives/husbands Working wives/husbands

22. Slide 22 Solutions Affordable Healthcare Affordable Healthcare Singapore Healthcare Singapore Healthcare Lee Kuan Yew: “Free medical services collided with the reality of medical behaviour” Lee Kuan Yew: “Free medical services collided with the reality of medical behaviour”

23. Slide 23 Peoples desire to achieve and succeed must never be compromised by an over generous state Peoples desire to achieve and succeed must never be compromised by an over generous state

24. Slide 24 Develop a sense of responsibility for all aspects of life Develop a sense of responsibility for all aspects of life

25. Slide 25 Co - Payments Essential at every level Essential at every level

26. Slide 26 Insurance plans that give first € coverage play a major role in increasing costs Insurance plans that give first € coverage play a major role in increasing costs

27. Slide 27 Provide price transparency by publishing costs Provide price transparency by publishing costs

28. Slide 28 Singapore white paper 1993 Promote good health Promote good health Promote individual responsibility Promote individual responsibility Ensure good basic services for all Ensure good basic services for all Engage competition and market forces Engage competition and market forces Intervene only when necessary to keep costs down. Intervene only when necessary to keep costs down.

29. Slide 29 Collaboration between Ministries Housing: designed for ageing Housing: designed for ageing Water Water Food supply Food supply Waste disposal Waste disposal Road traffic Road traffic Parks Parks Tree planting Tree planting Infrastructure: pavements Infrastructure: pavements

30. Slide 30 Role of Outpatient Satellite Dispensaries General Practitioner Care General Practitioner Care Immunisation Immunisation Health promotion Health promotion Health screening and early detection Health screening and early detection Well women's programmes Well women's programmes Nutrition advice school programme Nutrition advice school programme Psychiatric counselling Psychiatric counselling Dental care Dental care Pharmaceuticals Pharmaceuticals

31. Slide 31 X RAY X RAY Laboratory Laboratory Home nursing Home nursing Rehabilitation services Rehabilitation services Management of chronic disease Management of chronic disease

32. Slide 32 Are Singapore principles working? Are Singapore principles working?

33. Slide 33 Spend Singapore4% of G.D.P Singapore4% of G.D.P USA16% USA16% Ireland9% Ireland9%

34. Slide 34 Annual Government spend is 1.5% Annual Government spend is 1.5%

35. Slide 35 Per capita spend on Health USA $7000 USA $7000 SINGAPORE$2000 SINGAPORE$2000 Ireland$3000 Ireland$3000

36. Slide 36 Acute beds Singapore 20:10,000 Singapore 20:10,000 Ireland30:10,000 Ireland30:10,000

37. Slide 37 Looming Problems Ageing Population Ageing Population No financial planning or provision No financial planning or provision

38. Slide 38 Statistics of Ageing 2014 Over 65’s = 11% of the population Over 65’s = 11% of the population Over 65’s = 50% of the hospital beds Over 65’s = 50% of the hospital beds2034 Over 65’s = 22% of the population Over 65’s = 22% of the population Over 65’s = ??? 100% of the hospital beds Over 65’s = ??? 100% of the hospital beds Over 85 year olds occupy over three times the number of beds annually. Over 85 year olds occupy over three times the number of beds annually.

39. Slide 39 Degenerative Disease Over 65 yrs., 2/3 population have at least one chronic disease Over 65 yrs., 2/3 population have at least one chronic disease 1/4 have two or more 1/4 have two or more Demand for healthcare increases by 6% annually, i.e. 24% in 4 years Demand for healthcare increases by 6% annually, i.e. 24% in 4 years

40. Slide 40 Conditions of Ageing Our bodies are outliving our brains Our bodies are outliving our brains Dementia and Parkinson's disease Dementia and Parkinson's disease Skeletal Disease Skeletal Disease Ophthalmic Conditions Ophthalmic Conditions Cardiovascular Cardiovascular

41. Slide 41 Reform of GP Practice Review entry requirements for training programme Review entry requirements for training programme New well equipped health centres, tax incentives New well equipped health centres, tax incentives Direct referrals for diagnostics Direct referrals for diagnostics National Electronic Medical Record National Electronic Medical Record Minimise hospital referrals Minimise hospital referrals

42. Slide 42 Retain control of your patients Retain control of your patients Reform medical insurance Reform medical insurance Use cheap technology where possible Use cheap technology where possible Text Messaging, Online Bookings Text Messaging, Online Bookings Develop one to one relationship with Consultants Develop one to one relationship with Consultants Manage chronic disease Manage chronic disease

43. Slide 43 Optimise your time Optimise your time Importance of Flexibility Importance of Flexibility Increase investment in primary care, currently 2.5% of Budget Increase investment in primary care, currently 2.5% of Budget

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46. Slide 46 Proton Beam Therapy

47. Slide 47 Proton Beam

48. Slide 48 It is not about doing more with less. It is about doing it differently and innovatively.