GPs need the right to negotiate collectively
Competition law not appropriate for a profoundly different market
The formation of the National Association of General Practitioners (NAGP) last year was motivated not simply by concerns GPs had over the state of general practice, but by a belief that general practice was being ignored by government and that ultimately this would lead to the destruction of the specialty as we know it.
The decline of GPs’ turnover to the point where many have become insolvent was the driving force behind the formation of the NAGP and we have sought to work with the public, the Government and other unions to reverse this trend, not just for the survival of our members but to maintain the one part of the health service that actually works.
We believe that a fundamental part of the restoration of a thriving and workable general practice is the idea that GPs can have an input into how the service is run. This might seem obvious to anyone in any job – the people who deliver the service and the people who have dedicated their lives to providing a service should be consulted on how it is run.
Unfortunately, the Competition Act expressly forbids any kind of collective bargaining between GPs and the Government on pay or resources. And a recent deal agreed between the Competition Authority and the Irish Medical Organisation (IMO) – following a court case to decide the matter – seems to cement this idea.
What the IMO and the Competition Authority have agreed amounts to an acceptance of the status quo – that GPs cannot negotiate fees on behalf of their members
but instead will, well, what exactly? There are ideas floated that GPs will be consulted on changes to their jobs, their pay, their working conditions, etc, but at the heart of the agreement is the idea that doctors cannot negotiate collectively.
Across Europe, where this law originated, there is a growing acceptance that while it might technically be anti- competitive for doctors who all provide the same service to the State to negotiate with the State on their fees, it is, however, not the same or as straightforward as it would be for a regular business.
Firstly, there is no possibility of anyone else competing with a GP service. When we were building roads from Belmullet to Bandon, anyone who could lay tarmac could submit a quote and be accepted, whether they were based in Ireland or Spain. But we can’t import 2,500 GPs from Spain or anywhere else and maintain our quality service.
GPs are the only people who can provide the continuity and quality of the GP service in Ireland and, as mentioned previously, other countries such as Wales, Australia and Holland have realised this; these countries have suspended competition law to reach agreement and a long-term strategy with doctors.
No power to resist
In times of austerity
the Government will be tempted to take the most from those with no power to resist. They took medical cards from the sick and those with long-term illnesses (a practice GPs fought to highlight and were told cards were not being taken, in spite of the overwhelming evidence in their own surgeries).
In the same way, the Government is cutting resources for general practice, which is seriously affecting services and making many practices unviable. GPs have no way to oppose this policy, and it would seem the IMO is willing to accept that and hope that somehow, the Government will change its mind and suddenly fund general practice appropriately.
We will continue to advocate that the Government exempt general practice from the ridiculous constraints of competition law and use common sense, rather than a sense of loyalty to a broad European law designed for markets that are fundamentally different from ours.
We don’t want to wait days or weeks for a GP – even if that is the case in Europe in perfect competition. We don’t believe the “market” is a good regulator of people’s lives or illnesses. And despite our collegiality with the IMO, we believe they have made a fundamental mistake in accepting a decision that will ultimately undermine general practice in Ireland.
Chris Goodey is chief executive officer of the National Association of General Practitioners