Chris Goodey, of the National Association of General Practitioners recently argued on these pages that GPs need collective bargaining rights. As he is a professional lobbyist and head of a recently relaunched association set up to further the interests of GPs, a role traditionally performed by the Irish Medical Organisation, this is not surprising. In reality, however, it is more accurate to say that GPs want the right to collectively negotiate. They certainly don’t need it, and as taxpayers, neither do we.
Collective bargaining is a process whereby an employer negotiates directly with trade union representatives on terms and conditions of employment. The distinguishing feature of a collective bargaining process is that the union may legitimately co-ordinate workers’ activities and organise the collective withdrawal of labour if the employer proceeds with a course of action that they do not support. It is well-established law that labour has the right to organise and behave collectively in this way.
The same rights do not extend to businesses. When businesses get together to agree the terms and conditions under which they are prepared to supply a contracted service, this is called a cartel. When a sector becomes cartelised, consumers suffer. Prices go up and value for money deteriorates. Inevitably, suppliers are enriched and consumers lose out.
The General Medical Services (GMS) contract is the contract under which GPs provide treatment to public patients. GPs who sign up to a GMS contract are entering a contract for services. As self-employed professionals, GPs decide where to locate their practice, how much to invest in their practice facilities, who to employ, and whether or not to enter into partnerships with other GPs or medical professionals. In other words, GPs operate much like any other small business. For this reason, GPs are subject to the same Irish and European competition law rules as other businesses. Mr Goodey wrongly claims other countries such as Wales, the Netherlands and Australia have all suspended competition law when it comes to dealing with doctors. This is not so. Collective bargaining by GPs is not in fact permitted under competition law in any of these countries.
Up until the onset of the global financial crisis, in practice GPs and the IMO had been allowed to engage in collective bargaining and, as a result, had substantial bargaining power when it came to setting terms and conditions, including fees payable under the GMS contract. Over the seven-year period leading up to 2008, the start of the crisis, the average payment to a GP for treating public patients increased from €177 to €315. That’s an increase of 78 per cent. To put this increase in context, prices in the rest of the economy increased by 28 per cent over the same period. Even compared to the rest of the health sector, where the comparable inflation figure was 56 per cent, the magnitude of the increase in average per-patient payments to GPs seems extraordinarily high.
The Minister for Health and the State – not the IMO or the NAGP – are now firmly in the driving seat as regards decision-making. However, it is not the case, as Mr Goodey implies, that doctors have no input or say in how GP services are delivered. A Department of Health framework agreement establishes a process that allows GPs to engage with the department and the HSE on future changes to the GMS contract, including in relation to fees. The process even includes a mechanism which would, if required, involve a third party who can make a recommendation on fees.
For the last 25 years, nothing in the GMS contract could be changed in practice without the agreement of the IMO. The terms of the settlement agreement signed by the IMO on May 28th following a legal challenge by the Competition Authority indicate the IMO has accepted it does not have the power of veto over reform of the GMS contract. This case sets down a clear marker for medical and other professional representative organisations who provide services to the State.
Competition law provides protection to the State as purchaser. In 2012 alone, the Government paid GPs €445 million for treating public patients. The application of competition law means our health policy is determined by our elected representatives on our behalf, and not by GPs threatening to illegally engage in collective action, such as a mass withdrawal of services, if they don’t get their way.
Isolde Goggin is chairwoman of the Competition Authority and chair-designate of the new Competition and Consumer Protection Commission
