History Of The Formation Of The Medical Specialist Group And The Specialist Health Insurance Scheme

Until relatively recently, health care in the Bailiwick of Guernsey was delivered through 6 private and independent General Practices which provided a mixture of primary and secondary care.

Due largely to increasing specialisation within medicine, it became apparent that specialist doctors could no longer work from such small independent practices, and, in the 1980s, both the doctors and States of Guernsey saw the need for a major change in the way Health Care was organised. As a result, a number of external reviews were commissioned by the States to examine alternative ways of delivering specialist care.

In October 1990, the Board of Health submitted a paper to the States of Guernsey entitled "Health Care in Guernsey - Medical Services". This paper recommended that the old system of providing health care be developed rather than discarded altogether, and the States agreed that a separate specialist medical practice should be established and a 5 year strategy for health care be developed to ensure stability.

The Medical Specialist Group was formed on 1 January 1992 with 19 specialist founding partners, most of whom came from the original general practices. For the first 18 months, the Group was temporarily housed in Grandes Maison Road in St Sampsons and the service remained essentially private.

The Medical Specialist Group moved into Alexandra House, a dedicated outpatient medical facility, built and equipped by the 19 founding partners, on 1 June 1993.

In July 1993, the Medical Specialist Group contacted the Social Security Authority offering to contract for a system of health delivery that would enable secondary health care services on the island to be provided free at the point of delivery. This idea that was ultimately embraced by the States in January 1994 and in November 1995 a 7 year contract was agreed by all parties, commencing on 1 January 1996. This was paid for through the Specialist Health Insurance Scheme to which all islanders contribute. This contract has been re-negotiated for a 15 year period from 1st January 2003.

The Contract stipulates that all specialist treatment in Guernsey is provided at Consultant level. Whilst the Contract includes most of the services provided by the following specialties - medicine, general surgery, orthopaedics, ENT, anaesthetics, obstetrics and gynaecology and paediatrics - some specific exclusions still apply, including:

Non-specialist Accident and Emergency assessment and treatment
Dentistry and oral surgery
Contraceptive procedures and infertility treatment
Screening programmes eg sight and hearing tests (breast screening is included)
Cosmetic procedures
Care provided outside the Bailiwick and by some visiting specialists
Patients from Sark

Patients can only be seen at the Medical Specialist Group via a direct referral from their General Practitioner, usually by letter. The Consultant to whom a referral is made prioritises the referral according to its clinical urgency and an appointment is then forwarded to the patient by the Consultant's P.A.

Referrals to UK Consultants may occasionally be necessary on the advice of a local specialist and this treatment, as well as transport to and from the UK for the appointments, is also covered under the Contract.

Patients are entitled to seek a second opinion under the Contract and if this is not available locally then further opinions and advice are available through NHS Consultants at the expense of the States of Guernsey. Private off-island treatment and second opinions are at the expense of the patient and/or their Insurance Company.

There are high quality controls and standards included in the Contract which exceed those set as targets in the UK. Compliance with these quality standards has been very high and to the satisfaction of the States of Guernsey.