White tells IMO that GP fees unlikely to be cut further

The Government does not intend to introduce further cuts to the professional fees for general practitioners barring any unforeseen events, Minister of State at the Department of Health Alex White has said.

Addressing a special meeting of GPs at the Irish Medical Organisation (IMO) conference in Maynooth today, Mr White said the department would be taking steps to seek additional resources for primary care and general practice in the forthcoming estimates process for next year's budget.

He strongly defended the Government’s plans for the introduction of free GP care for children aged under-6 which has been roundly criticised by the IMO.

Mr White said that a decision to see a doctor should never present a financial dilemma for anyone.

He rejected suggestions that the Bill, which he published in recent days to give effect to the free GP care initiative, could be used as a proxy in the future for financial emergency legislation under which the Government has cut fees and allowances paid to GPs over recent years.

Mr White urged the IMO to take part in what would amount to “talks about talks” in relation to the plans for free general practitioner services for children aged under-6.

He said there were many issues relating to a proposed contract for the new service which could be negotiated with the IMO but that the ultimately setting of the fees to be paid had to remain a matter for the Minister.

There was strong legal advice from the Attorney General that under competition law the Government could not negotiate on fee levels with GPs who are independent contractors and not employees of the HSE, he said.

Mr White said the Government had no plans to change competition law as this stemmed from an EU directive. However, he said the Government would “stretch and stretch” its room for manoeuvre.

The Minister also rejected suggestions made by doctors that general practice would be overwhelmed if fees were abolished for all young children.

He suggested the IMO and the health service could work on a joint assessment of projected visiting rates.

Mr White said some surprise had been expressed last week at the fact that all children aged under-6, including those currently covered by medical cards - would derive eligibility for free GP services under the new legislation.

“But a universal service requires that it is just that - a unitary scheme, available to all children under-6 without distinction. It would be quite wrong - and would run counter to the very objective we are seeking to achieve - if we were to maintain two categories of under-6s and frankly there was never any question of doing so.”

He added: “For clarity, I should point out that the other medical card entitlements currently enjoyed by children under 6 will not be affected in any way. For example, a child under-6 with a standard medical card will continue to receive their prescription drugs and all other services under the existing GMS scheme.”

The Minister told the meeting, which was attended by about 350 doctors, that there was still considerable work to be done to finalise a contract for GPs.

He said some elements of the draft GP contract set out by the HSE had been misrepresented or misunderstood and that the document remained a draft for consultation.

“Perhaps because of the lack of communications between us, or a want of trust on all sides, or for whatever reason, the draft has been wrongly characterised as an actual offer to GPs or as a fait accompli. That was never either our intention or expectation.”

He said he would characterise the document not as a fait accompli but rather a work in progress.

The Minister was greeted with silence as he entered the meeting and there was no applause when he concluded.

For more than an hour he took part in a question and answer session with GPs who were strongly critical of his plans.

The Minister strongly rejected assertions that medical cards had been taken from older people or those with serious illnesses to be given to more wealthy patients.

He also took issue with concerns that medical cards would be given to the children of millionaires or billionaires.

Mr White said the State did not charge the children of the wealthy for primary schooling and asked why this should not also be the case for healthcare. He said the tax system could be used to pursue equity in relation to millionaires and billionaires.

Earlier the chairman of the IMO's GP committee Dr Ray Walley told the meeting that the organisation supported GP care, free at the point of access for all citizens.

However, he said it needed proper planning, resources and negotiations.

Dr Walley said morale among GPs was at an all- time low. He said over recent years €454 million had been taken from general practice while, at the same time, the workload was growing.

He said that more than 1,000 trained GPs had taken up positions in the UK and now for the first time middle aged GPs were also leaving to work abroad.

Dr Walley said the proposed new contract for the provision of care for children under age-6 was unacceptable.