GPs and the Competition Authority


Sir, – I wish to take issue with a number of claims made by Isolde Goggin (“General practitioners operate much like any other small business”, Opinion & Analysis, August 18th).

First, the National Association of General Practitioners (NAGP), which represents over 1,000 GPs, has been excluded from talks with the Department of Health, which would in itself seem to be anti-competitive behaviour. To endorse one organisation over another surely raises questions about the impartiality of the department in this area.

Second, the primary motivation of GPs is the desire to provide a first-class, safe and effective service at primary care level. The ability to be able to negotiate collectively is not so GPs can go on strike or withdraw services but to allow GPs to have a voice on behalf of their patients at the highest levels, to ensure that the poor, the elderly, the socially deprived and most vulnerable in our society can continue to access health in their community safely and effectively.

Third, general practice is not a trading business in the traditional sense of the word as 80 per cent of its income comes from one source, namely the HSE. As a result of Fempi (Financial Emergency Measures in the Public Interest), GPs have had their gross income cut by 40 per cent in the last four years.

This is not a 40 per cent salary reduction but 40 per cent of resources provided by the State to provide a health service at primary care level. This funding is there to provide infrastructure, equipment, heat, light, staffing, insurance, etc. As stated previously, these are gross payment reductions and actually equate to a net 80 per cent reduction in income.

If the Government had slashed the hospital budget to the same degree half the hospitals in Ireland would be now closed. But the Government doesn’t cut the hospital budget to the same degree because the employees of these organisations are protected by their unions.

Fourth, Ms Goggin claims that GP fees rose by 78 per cent over the seven-year period leading up to 2008 but this figure is quoted out of context. Indeed resourcing in general practice did rise over this period but GPs were asked to do much, much more for the money.

For example, free GP care was provided for the over-70s and numerous other services were provided by GPs in a primary care setting over those years. Unfortunately these services are now being cut or have been eliminated because of a lack of funding.

Unlike other businesses, general practice is unable to cut costs and continue to provide a safe service. An increasing number of patients are presenting in general practice while draconian cuts are being implemented, which means that it is the patients that suffer because GPs cannot fund the service themselves.

The Competition Authority has conveniently ignored that the GMS scheme is by its very nature anti-competitive. The idea that one supplier can impose fees by diktat to businesses without the ability to negotiate is anti-competitive by its nature. What other business could possibly survive in this type of economic tyranny?

The National Association of General Practitioners represents GPs but by extension is also trying to protect the poor, the vulnerable and the socially deprived in our society. We will continue to highlight the failures of successive governments to address the key issues in providing a safe, effective service at a primary care level for all the people of Ireland, not just the well-off. – Yours, etc,


Chief Executive,

National Association

of General Practitioners,

Kildare Street,

Dublin 2.

Sir, – Ms Goggin believes that currently GPs decide: 1) “where to locate their practice”, but the new contract stipulates that GPs shall work in Primary Care Centres where available; 2) “how much to invest in their practice facilities”, yet the new contract insists that GPs have a state of the art IT system, and lists the various types of rooms that must be provided, including a dedicated mother and baby feeding and changing room; 3) “who to employ”, yet the contract says that any locum employed by GPs must be approved by the HSE first; 4) “whether or not to enter into partnerships with other GPs or medical professionals”, yet the new contract decrees that GPs must be members of the local Primary Care Team.

What is proposed is not a new GMS contract, but an entirely new primary care contract, which will radically change the doctor-patient relationship as we know it. – Yours, etc,


The Surgery,

Market Street,


Co Kerry.