Swords drawn as HSE and GP representatives battle over pay
The introduction of universal free GP care during its current term was one of the key Government pledges
The Minister for Health, Dr James Reilly: free GP care a core objective. Photograph: Michael Donnelly/ Collins Photos
There are high stakes involved for all sides in the row between the Government and general practitioners on the Government’s plans for introducing free GP care for children under the age of six.
The Irish Medical Organisation (IMO) and other groups representing GPs are deeply unhappy both at the content of the draft contract drawn up by the Government for the proposed new service and at the insistence of the Department of Health that it will enter only into consultations and not negotiations on the issues.
Last week the IMO warned that it would consider seeking an injunction to prevent the Government introducing changes to the contracts of its members without agreement.
For the Government, the introduction of universal free GP care is one of the key commitments to be introduced during its current term.
The implementation of this initiative has already been delayed by the abandonment of the original intention to start the process by providing free GP care to those covered by the long-term illness scheme.
The Government then opted to introduce free GP care on an age basis, commencing with children under the age of six this year. However, if this move is stymied or delayed significantly , it would have serious implications for the intention to have free GP care for all in place by 2016, an ambition the Minister for Health, Dr James Reilly, has said is still achievable.
Failure to deliver on free GP care, or at least to make a significant start on the road to universal coverage, would also raise serious credibility issues for the Government in relation to its overall aim of introducing a system of universal health insurance at some stage in a second term of this administration.
For the IMO, the current situation is equally serious. The Government has argued that it cannot, under competition law, negotiate with the IMO over fees.
It has offered consultation on the elements of any new contract covering medical care for children under six, as well as an input into any fee structure.
At the end of the day, all the aspects of the draft contract may not make it into a final document. The Department of Health and the HSE could be seeking to throw the kitchen sink and all into the draft in the knowledge that this could ultimately be pared back to what they really want.
Certainly the Government would like to move primary care in a direction of health promotion, etc rather than just dealing with illnesses that present.
However, there are other aspects of the draft proposals – such as the gagging clause to prevent criticism of the HSE – which it is difficult to believe could present a fundamental bottom line for management.
Template for contracts
The IMO suspects that whatever emerges in the final contract for services for children under six, is likely to be the foundation of subsequent contracts with doctors as free GP care is rolled out to other age cohorts.
Different governments over recent years have all spoken about changing the current GMS contract with GPs, without much ever happening.
The draft proposals for care for children under six could prove to be the new overall contract in embryo.
If the IMO is unable to negotiate on the terms of any such deal under competition law and is merely consulted on the nature of the elements in it, questions would likely arise about its relevance as a trade union with subscriptions of up to €1,200 per year.