GP and consultant pay should be the same, group says

General practitioners should have commensurate rates of pay with hospital consultants, the National Association of GPs (NAGP) has argued in a submission on a new contract for family doctors.

It said pay for GPs should reflect their level of expertise, training and responsibility.

The NAGP has also called for GPs in rural and deprived urban areas to have the option of becoming State employees.

At present all GPs working in the State medical schemes are independent contractors.

The NAGP said that family doctors had been under increasing financial pressure in recent years as a result of various cuts introduced to State payments at a time when the level of services provided had evolved and expanded.

“As a consequence some GPs are leaving the system and new GPs are not taking up positions because it is not financially viable for them to do so.”

Underfunding

The NAGP maintained that cuts to GP payments introduced under financial emergency legislation must be immediately reversed and overall underfunding of general practice should be urgently addressed by the Government.

"The percentage of the healthcare budget in Ireland spent on GP services is in the order of 2.5-3 per cent.

“As a comparison, the budget for GP services in the UK is of the order of 9 per cent.”

The NAGP said if the Government continued to extend free general practitioner services to increasing cohorts of patients, family doctors would essentially become employees of the State “and will require an employee contract based on hospital consultant levels”.

It said this would include pension, sick leave and all the usual entitlements of State employees, as well as the provision of premises and staff, IT and overheads.

“If, on the other hand, GPs are to remain self-employed with all the risks entailed, in a situation where the State wishes to continue with provision of free GP care at point of access, a different system other than the current unlimited visits for a fee decided by the State (which does not reflect the range of services provided by GPs) will be necessary.

“A basic capitation payment for basic acute services, with a range of additional services paid on a fee-per-item basis, reflecting the resources involved, might be considered.

“This would have to be combined with contributions towards premises and IT, as well as significant changes in sick-leave entitlements and pension.

Opting out

“The idea of making out-of-hours work the subject of a separate contract was discussed by the NAGP and found some favour, giving GPs the option of opting out of this work.”

The NAGP argued that a new contract also needed to address the issue of GPs having to make redundancy payments to long-serving staff in cases where they were retiring and there was no other family doctor to take over the practice.

“This is a situation which is arising in the current climate of uncertainty in general practice, whereby young GPs are not willing to take over closing practices, leaving the retiring GP in this vulnerable position.”

The Government has set a deadline of next spring for the development of a new contact for GPs operating the State’s various medical schemes.

However the NAGP has not been invited to take part in talks on this proposed contract which are currently being carried out between health service management and the Irish Medical Organisation.

According to an OECD report published last July, GPs earned an average of €115,940 in 2013, down from €118,677 the year before.

The OECD said that hospital consultants earned €164,494 on average in 2014, not including private income, down from €173,646 the previous year.

The OECD figures are , however, strongly disputed by medical organisations.