The negotiators from the Irish Medical Organisation (IMO) and a HSE/Department of Health conglomerate have agreed on a deal that will, among other things, provide GP visit cards to all children under six. It will be up to each GP to decide whether they will sign up for this addition to their contract or not.
There are many implications for Irish GPs, their patients, the health service and, eventually, the Government and other political parties.
The GPs are split, roughly, into two camps; the IMO camp and the National Association of GPs (NAGP) camp. The Irish College of General Practice has so far given the deal a cautious welcome. Some feel the contract is not ideal, but could be worse. In fact, it was worse. About a year ago the GPs and the new GP union, the NAGP ,were presented with an initial draft that included a gagging clause, forbidding anyone who held a GP contract from speaking out against the HSE, and other unworkable proposals. In fact, it was so bad it was good, as it mobilised GPs and roused the IMO.
The NAGP, founded in response to the huge pension allocated to former IMO chief executive George MacNeice, travelled around the country raising awareness of the perilous state into which general practice had fallen with politicians and policy makers.
The NAGP is not best pleased with the IMO deal. It feels that while money is tight, it would be better to give money to the next 200,000 patients just above the medical card threshold instead of giving GP visit cards to the children of millionaires. It is hard for a parent to pay for their seven-year-old chronically sick child’s treatment when their healthy five-year-old has a GP visit card. They feel the proposal is not based in best practice and was introduced to get the Government re-elected.
It is not just about the money. In fact, the fee negotiated for each child is not too bad. Some GPs remember the GP contract of 1989, which delivered a lot for Irish general practice.
The initial payments were modest but some sensible methods of practice support followed. International evidence confirms that what is good for general practice is good for the health of the country, and general practice was hit out of all proportion by the FEMPI cuts. Many practices have either gone out of business or are close to ruin. Young GPs are leaving and rural practice is in crisis. The HSE has a lot to do to put the pieces back together.
If people are given free access to GP care, they tend to attend more often. There could be, says the NAGP, an extra 4.5 million consultations annually. General practice is stretched already and suffering a recruitment crisis. There is the real prospect that waiting lists may have to be introduced here for the first time. In the UK patients may wait for a week to access their GP.
Two-tier system
The Government wants to bring in universal healthcare. The under-six contract is the start and in time they will extend the scheme to include everybody in the country and the two-tier system will be no more. Irish GPs are not against the idea of a universal health service. But they know that they have to have the right infrastructure and resources to deliver effective care. Maybe the day will come when the health service nationalises the GPs, puts them in government-owned health centres and pays them a salary. But it is difficult to decide on the basis of what it might lead to. A different government could have a different plan, or none at all. On the other hand, opposition parties have a habit of lambasting a government proposal and then adopting it when they achieve power.
A lot of GPs I know are somewhere in the middle and each will have to make up their own mind. It is a bit like the Treaty negotiated by Collins and initially rejected by DeValera. We see the formidable negotiators from the IMO and wonder if anyone could have achieved a better deal. Sometime this summer a parent will come to each of us with a form to grant their kids a GP visit card. If one GP refuses to sign it, maybe the GP down the road who is loudly protesting will not. It will be an interesting summer, with plenty to talk about.
Dr Muiris Houston is on leave. Dr Pat Harrold is a GP in Nenagh, Co Tipperary.
* This article was amended on May 5th to clarify references to GP visit cards.
