Why are doctors so angry about plans for free GP care for under-6s?

During what was the largest gathering of family doctors for many years, almost 500 GPs packed into a Dublin hotel last Wednesday to protest at the crisis they perceive in their profession.

This was only the latest in a series of regional meetings at which doctors have voiced their many grievances about resources, fees and the Government’s imminent plans to extend free GP care to the under-6s.

The mood comprises equal parts anger and frustration. GPs say successive fee cuts have knocked almost 40 per cent off their gross earnings, leaving many practices in dire financial straits. Private patient lists have been decimated by unemployment and emigration. A range of extra services is being provided despite meagre or no recompense from the HSE, they claim.

And now the Government wants them to treat all under-6s for a set yearly fee.

The context is a period of rapid change. The under-6s plan is merely a way-station on the road to free GP care for all under Minister for Health James Reilly’s plan. The Minister is also in the throes of protracted plans to develop primary care teams. GPs would be just one of the professionals providing services in these teams.

In any other sector the workers would bang the drum for more money, the Government would plead penury, and eventually both sides would sit down and strike a deal. It’s more complicated here. Unlike most other European countries, GP services in Ireland are provided by the private sector. Family doctors run small businesses, though for most of them their main client is the State in the form of the HSE.

It isn't practical for the State to negotiate fees and conditions with each individual doctor but there are strict rules under competition law restricting the ability of representative groups such as the Irish Medical Organisation to negotiate on behalf of GPs. Hence the current standoff between the Government and the IMO.

Minister of State for primary care Alex White has published a draft contract for the under-6s and has invited the IMO twice to talks on its contents. But he says it's up to Dr Reilly alone to set the fees involved. The IMO says it won't talk until everything is on the table.

The issue could be resolved by a court case being taken by the IMO on the issue, but a decision could take months and will probably be appealed anyway. Alternatively, the Government could decide to amend competition law to allow representative bodies to negotiate on behalf of members. However, the law of unintended consequences could arise in other sectors if such a change were made.