It has been a good news/bad news week for the Republic's general practitioners. A majority voted in favour of the Government's pay offer to cover the cost of extending medical cards to everyone over the age of 70 years. Despite earlier protests about the need to ensure free medical care to more needy groups first, the offer of an annual fee of £365 per patient for new entrants to the scheme was too attractive to turn down.

That was Thursday. The previous day, The Irish Times revealed far-reaching changes to the primary-care system, changes which would impact greatly on family doctors. Both individual practitioners and representative organisations feel significantly threatened since Wednesday by the proposal, in a health strategy document, to create a "one-stop-shop" primary-care team.

The present system acts as a medical filter and is based on a patient presenting a problem to a family doctor who will usually offer treatment or investigation. In more urgent cases or when initial treatment fails, the patient is referred to the hospital system for further management.

The new proposals contained in the document, titled Recommendations for Primary Care: Your first point of contact and your ongoing contact with the Health & Personal Social Services, clearly break this gatekeeper role.

Patients will be encouraged to register with an expanded primary-care team, which will consist of nurses, therapists, pharmacists, social workers and community welfare officers as well as doctors and dentists. Crucially, a patient will be able to choose whom he attends first from the different disciplines.

For example, if you have a sports injury - say a bruised muscle in your leg - you could choose to attend a physiotherapist, practice nurse or the general practitioner. Or if you ring in to the team with concerns about your 14-year-old daughter's behaviour, you could be directed to a social worker just as readily as the GP.

One of the principal drivers of this change is a desire to create a primary healthcare system that is accessible regardless of a person's ability to pay; by doing this, real health gain is achievable through earlier prevention of illness. It aims to move much treatment and rehabilitation back into the community.

Of course, this nicely achieves another key objective - the relief of the cluttered and slowly collapsing hospital system. And, depending on how it is funded, it offers the potential for considerable cost savings.

For all of these reasons, doctors must take the proposals seriously. There has been the predictable knee-jerk reaction: "a return to the bad old days of the dispensary system" and "do we really want East European-style polyclinics?" are some of the recent comments.

A more solid argument, and one which the Department of Health will have to consider carefully, is the real danger that the personal relationship between a patient and GP will be severely diluted. There are many health problems which never progress beyond the GP for the simple reason that his knowledge of the patient and family allows for low-key effective solutions. What price are such valuable relationships in the impersonal environment of an 1850 telephone number and large primary-care teams?

Nor does it suit every health professional to work in a team environment. The present system allows for a range of individual arrangements, most of which work quite effectively. It will also require a considerable education campaign aimed at patients to ensure an acceptance and understanding of the new system.

One of the principal reasons why medical organisations will resist these changes is the potential for both loss of income and the loss of independent contractor status. Being self-employed is a dearly held status for most family doctors. The loss of autonomy associated with becoming a team member without an acknowledged leadership role will be fiercely resisted by a majority of GPs.

Even more horrifying to most is the inherent assumption in the proposals that all team members will be salaried. This is a bridge too far and the Minister for Health would be well advised to make it clear that a salaried GP service is not what he has in mind when he presents the final health strategy document.

The Irish Medical Organisation will almost certainly insist on a team leadership role for GPs as a precondition to even considering the primary-care proposals. The Irish College of General Practitioners will want to explore a development of a more limited form of primary-care team involving GP, practice nurses and public-health nurses.

It is probable the document was given to The Irish Times to initiate a public debate on the issue; if this is the case, then the sooner the Department of Health officially circulates it to all stakeholders, the better.

No one should underestimate the importance of this primary-care plan; doctors would be ill-advised to dismiss its content as "unworkable". There are too many benefits for all stakeholders and strong indications from within the Department of Health that it will form a key building block of a new health service.