The Association of General Practitioners (AGP) is planning to serve a summons on the Voluntary Health Insurance Board, seeking an interlocutory injunction preventing the start of a new insurance scheme.
The VHI has proposed a new initiative, a primary-care cover scheme designed to mirror the insurers' current arrangements with hospitals and consultants.
Costing £30 million a year, the proposal has met with stiff resistance from doctors. The recent IMO conference saw a prolonged debate on the matter, at the end of which IMO leaders were refused a mandate to enter into formal negotiations with the insurer.
The a.g.m. of the Irish College of General Practitioners was told by Dr Michael Daly that the substance of his group's legal move was to prevent the VHI from abusing their dominant position in the healthcare market.
Dr Daly said his association's members were extremely concerned that the public might have already been misled by documentation purporting to claim that a panel of GPs was already in place to provide care on behalf of the VHI.
Inequality fears and the creation of a three-tier system of healthcare were the main concerns of speakers at the meeting. Dr Declan Murphy, of the Kilkenny Faculty, spoke of the malign influence of an existing two-tier hospital system in which a consultant-provided service is available in the private sector but only a consultant-led level of care is afforded to public patients.
"I see the entry of private insurers into general practice as having the potential to create a three-tier system in which there are medical-card patients, private patients and a group who have no system of entitlement whatsoever," he said.
A Kilkenny Faculty motion seeking the inclusion of all members of the public in any future VHI general practice scheme was unanimously carried.
Dr Stephen Murphy, a Dun Laoghaire GP, proposed a motion, subsequently carried, "that this a.g.m. reaffirms that the Irish College of General Practitioners should be the body to set standards of practice and that it should not be left to an insurance company to dictate or influence these practices for commercial purposes".
Dr Murphy welcomed assurances from the college officers that no negotiations had been or would be entered into by the ICGP with the VHI.
Dr Michael Boland, director of the college's Postgraduate Resource Centre, told delegates the profession should not accept any attempt by an insurance company to interfere with the rights of patients to choose a doctor.
However, he drew attention to international experiences concerning the influence of funding methods on the quality of GP services, which suggest it is best to have a mixed system of healthcare payments in order to maintain professional quality and standards.
Several doctors expressed concern about the future influence of private insurers on their clinical freedom, including prescribing choices, should the VHI primary care scheme go ahead.
The GP committee of the IMO, the profession's trade union, is due to have further discussions with the VHI this week. The Irish Times understands they will agree to proposals for the insurers' involvement in private patient registration but will reject any agreement on consultation fees.
The VHI is unlikely to find such a compromise compatible with its plans for primary care, and the unilateral introduction of the new product by the private insurer is still the most likely outcome to the present impasse.