Doctors unite as fee cuts and new proposals fuel frustration

Last year it was junior doctors and now it is the turn of GPs to rise up in anger at their working conditions in the health service. Thousands of normally mild-mannered family doctors have been venting their frustrations at fee cuts and proposed contract changes at meetings across the country in recent weeks.

Last week's meeting for doctors on the eastern seaboard saw almost 500 GPs pack the ballroom of a Dublin hotel for a marathon session that continued late into the night. There were standing ovations for colleagues who spoke about their work travails, and mild barracking for Government backbenchers who dared to question the doctors' current industrial relations strategy. Support came from figures as politically diverse as former University of Limerick president Ed Walsh and People before Profit TD Richard Boyd Barrett.

Several speakers claimed that general practice was the only area of the health service that was functioning properly, an assertion that is unlikely to find favour with hardworking professionals in other health disciplines. The turnout of politicians was impressive, but at the end of the evening there was little sense of the approach doctors could take to achieve their demands.

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Dr Stephen Murphy, chairman of the East Coast GP Committee of the NAGP.

Fee levels payable in respect of medical card patients have been cut by almost 40 per cent under the Fempi (Financial Emergency Measures in the Public Interest Act) cuts, but speaker after speaker emphasised that it was wasn't about the money. General practice is being starved of resources, the meeting was told, at a time when GPs are being asked to provide more services for more patients, most recently the proposed provision of free care to under-sixes.

'Safe service'
Ciara Kelly, a GP in Greystones, says her practice can no longer provide medical card patients services previously regarded as routine, such as blood tests or blood pressure monitoring, because of the cuts in support. Staff have taken two pay cuts and their hours have been reduced. Her own mortgage has gone into arrears. "I cannot provide the level of safe service needed on €7-8 a month per patient. It's a shoestring service now and patient care will suffer."

The Government's plan to extend free care to all under-sixes have incensed Kelly and other GPs. "Every day of the week, I see deserving patients losing their medical cards – the elderly, people with terminal illnesses, patients who are housebound in a wheelchair. These people are paying huge amounts now for their care, yet the Government is going to provide cards to the worried well who can afford to care for their children. It's a vote-catching exercise, a recipe for disaster."

Draft contract
The specifics of the draft contract for treating under-sixes drawn up by Minister of State for Primary Care Alex White has also angered doctors – in particularly a gagging clause and provisions requiring doctors to gather patient information, such as children's weight.

"Change for change's sake" was how Aifric Boylan, a GP from Co Meath, described the changes which have driven her to opt for emigration. After all her years of expensive medical education, and despite providing a service that is much needed and in short supply, Boylan leaves for Australia in three months' time along with her two children.

There was plenty of anecdotal evidence at the meeting of the threat of medical emigration further depleting the health system. Kelly says 11 of the 24 doctors on her GP training scheme are leaving, while virtually all the trainees coming out of UCD are said to be similarly minded.

At the other end of their careers, older doctors are said to be retiring early rather than endure the frustrations of working in an under-resourced health system. But for those in the middle, with nowhere to go, the options are less clear. Unlike junior doctors, GPs are self-employed, and the Irish Medical Organisation is prohibited under competition law from negotiating on fees on their behalf. The IMO is challenging this in the courts, but Eddie Hobbs delivered a stark warning to doctors on this issue at last week's meeting. Fighting the case will cost the union at least €1 million, any decision will probably be appealed to the Supreme Court and ultimately it will lose, he predicted. Even if the IMO did win the case, it would mean that GPs would be treated as employees of the HSE, with all the risks that involves.

On this reading, the legal strategy of the IMO seems like a beaten docket. Neither is its refusal to talk to Mr White sustainable in the long run. A better approach was suggested by former junior minister in the Department of Health, Róisín Shortall, who said that while the hands of the IMO were tied on pay negotiations, it could still negotiate on related issues, such as the proper funding of primary care and the upgrading of premises. She also suggested an independent assessment of the real costs involved in providing care for medical card patients.

The situation is complicated by the emergency of the National Association of GPs as a rival to the IMO. The NAGP, which organised the recent meetings, doesn’t hold a trade union negotiating licence but it is close to having the 1,000 members that would allow it apply for such a licence. Competition between the two organisations goes some way to explaining the activity on the issue, but ultimately solutions are going to have to be found through negotiation rather than showboating.