The State's family doctors have told politicians to stop handing out medical cards as election promises.
And a leading GP has described the Government's proposals for primary care as a "Bertie Bowl" which, at best, offers a medium to long-term solution to the crisis in general practice rather than meet urgent needs.
Dr John O'Brien, chairman of the membership committee of the Irish College of General Practitioners, told the organisation's AGM that rather than supporting and developing general practice, the primary care strategy sought to create a new structure.
"The likely outcome is that the strategy won't work and that a great deal of money will have been spent proving that point."
He said general practice had immediate and pressing needs.
Instead of meeting these needs as a matter of urgency, what had been brought forth was a "highly-aspirational, largely theoretical document".
Speaking to a motion, "That this college believes general practitioners are increasingly prohibited from providing equitable and adequate services to medical card patients and are particularly unable to do so in terms of preventative medicine," Dr Brendan O'Shea, a Kildare GP, referred to the "promising plague" sweeping the country at present.
"Many GPs across the State are quite alarmed at suggestions that the general medical scheme be extended. It is a fatally flawed system based on 1970s standards, which is unworkable in key respects for both patients and doctors."
Dr Ciaran Donovan, a Cork GP, said that politicians' election promises were a scandal. "Don't be doling out medical cards to under 18s just for votes," he said to sustained applause. "Our resources are limited and need to be targeted at those who cannot afford medical care."
Criticising election promises, Dr Richard Brennan, chairman of the college, said that the political parties have not recognised the crisis in general practice.
"Practices are not able to absorb any more work at present. None of the parties have explained what they mean by a free GP service or what quality standards will apply.
"Do they propose a continuation of the existing model which is essentially a firefighting approach to health?"
He claimed general practitioners were at present carrying primary care.
The meeting heard of the urgent need to deal with manpower problems in general practice.
Dr Kieran Harkin, a GP in Inchicore, proposing a motion to deal with the special healthcare needs of deprived and disadvantaged areas, said there were four practice vacancies in his area of Dublin which were proving extremely difficult to fill.
Referring to the flight of GPs from the heavy workload and under-resourcing experienced in deprived urban areas, Dr O'Brien said: "In the more affluent areas of Dublin, the ratio of GP to population is 1: 1,300. The remainder of the city has a ratio of 1: 1,800."
Dr O'Brien added that "in my own practice, two GPs are going on maternity leave and no replacements can be found for them. Throughout the country GP's have closed their lists to new patients."
He said there were a number of reasons for the manpower crisis in general practice.
"The bulk of GP graduates are now female and are often looking for family-friendly working conditions.
"In addition, the number of GP training places has been inadequate for a number of years."
Referring to the finding that 20 per cent of trained GP's are no longer working in general practice after five years, he said the exact reason for this is not available but may relate to the workload and the remuneration.