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STATES OF JERSEY
PROPOSED GOVERNMENT PLAN 2023- 2026 (P.97/2022): SIXTEENTH AMENDMENT (P.97/2022 AMD.(16)) – COMMENTS
MULTI-MORBIDITY GP CONSULTATIONS
Presented to the States on 8th December 2022 by the Council of Ministers
STATES GREFFE
2022 P.97 Amd.(16) Com.
COMMENTS
The cost of healthcare in Jersey is likely to rise significantly over the coming decades and current funding models will struggle to cope with these increased costs. Work is already underway by the Minister for Health and Social Services to review the funding and financing of healthcare. This work is proceeding over 2023 and will include specific consideration of fees within all aspects of primary care.
Until this work is complete it would be premature to create an additional cost pressure within the current health system. However, the Council of Ministers recognises that current fee structures within primary care may act as a disincentive to appropriate access, and potentially reinforce inequalities. For this reason, the MHSS's review specifically includes an examination of user charges within all primary care settings and how reduced user fees could be supported within a revised funding model.
There are a range of populations who could be selected to receive further financial support. These populations include those with multiple morbidities, but also could encompass other groups such as children (see Amendment 18) or the elderly .
The existing Heath Access Scheme (HAS) already supports low income households with low fixed cost general practice fees. The creation of an additional scheme as the amendment suggests, will not benefit those households who qualify for the HAS. Although the Council of Ministers recognises the impact the cost of living is having on a greater number of households, the benefits of the amendment would be felt by higher income groups.
It is also important to consider how reduced costs might affect the demand for health services. Some commentators have raised concerns that demand for GP services exceed current capacity, and that GP recruitment is problematic. Given the increasing prevalence of long term conditions, reduced costs for higher users of GP consultations may increase demand which currently could not be easily accommodated. This would increase pressure on GPs and possibly lead to a deterioration in service for all patients. The amendment seeks to remove at least £6.5million a year from the Health Insurance Fund. This is a recurring additional cost to be met from the HIF and the size of the transfer will increase over time as the number of islanders living with two or more health conditions is forecast to grow steadily.
An actuarial review of the HIF is about to commence with the results due to be published in the second quarter of 2023. It would be premature to commit this significant and ongoing additional expenditure in advance of the outcome of the actuarial review.
Conclusion
• The overall cost of healthcare in Jersey is rising steadily and action will be needed to meet future increased costs
• The need to review the use of user charges within primary care has already been identified and is included in the extensive review of health funding over 2023
• An actuarial review of the Health Insurance Fund is planned with results due in Q2 2023
• The amendment does not identify a sustainable funding source for the extra costs proposed
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Until Members have had the opportunity to consider the results of the two planned reviews, it is premature to commit a minimum of an additional £6.5m a year towards this scheme.
Members are urged to reject this amendment.
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