Family doctors are moving towards accepting the notion of free GP care for everyone, despite a vote against it at the Irish Medical Organisation's annual meeting a week ago, writes Maev-Ann Wren
Politicians who support free general practitioner care for everyone should not be discouraged by the defeat of a motion proposing a national GP system at the Irish Medical Organisation's annual general meeting in Killarney a week ago, a spokesman for the IMO has made clear since the vote.
The narrow defeat of the motion at a poorly attended meeting masks a sea change in doctors' views on the introduction of a comprehensive primary care service, general practitioners in the IMO have been suggesting in recent days.
Asked if the vote signalled the IMO's future political stance, Dr Martin Daly, IMO treasurer and a negotiator on the IMO's general practitioner committee, said: "I certainly wouldn't want any serious politician who had a serious interest in improving healthcare delivery for the patients and providers to be discouraged by that vote.
"If a Government had a serious radical proposal that guarantees and improves quality of care and breadth of access, the IMO would have to look seriously at it."
Ms Liz McManus, health spokeswoman for the Labour Party, has welcomed Dr Daly's remarks. The Labour Party proposes free GP care in the context of a comprehensive insurance-funded healthcare system. Mr Michael McDowell, the Attorney General and a general election candidate for the Progressive Democrats, recently described a free GP service as a "loony Left" idea.
Ms McManus welcomed "the positive approach" being taken by the IMO. "It confirms the experiences I have been having in talking to various professional bodies about our proposals for GP care. If properly designed and implemented, we can afford high- quality primary care which will shift the emphasis from hospital care. This will be good for the patient and there is no reason why it should not be good for the primary care doctor too. That message has got through now."
A free primary care system would "have to be designed carefully, in conjunction with the doctors and by negotiation", she said.
Only medical card holders currently receive free GP care. Other patients must pay each time they visit their family dcotor, with fees varying among doctors from €25 to €40 per consultation.
Dr Cyril Daly, a general practitioner in Killester and veteran Irish Medical Times columnist, proposed the motion in support of a national GP service which was debated at the IMO's annual general meeting in Killarney on Saturday April 6th.
The motion was narrowly defeated on a show of hands in a debate attended by some 50 to 60 general practitioners. The IMO represents 1,825 GPs.
The defeated motion stated: "That this IMO a.g.m. calls on the incoming Government to introduce a national whole population GP service, Exchequer or insurance based and seamless in its delivery of primary care to the poor and the rich."
The a.g.m. did, however, pass a motion calling for an immediate trebling of the income eligibility limits for the GMS.
Dr Martin Daly said the defeat of the motion should be seen in the context of "the last five years where people in the social welfare system have been squeezed out of the medical card system" and medical cards had been given to wealthy over-70-year-olds in preference to the poor.
"It is difficult for GPs to have any confidenc in the Government to be able to deliver any form of comprehensive primary care service," he said.
He said the motion had been only narrowly defeated in a debate without acrimony or vehement opposition.
Dr Cyril Daly, who has proposed similar motions for a number of years, commented following his latest defeat that the climate of opinion among doctors had "hugely" changed. A "sense of inevitability" had developed about the eventual introduction of a comprehensive system despite "strong pockets of resistance". If all GPs were balloted on a concrete Government proposal for free GP care, he thought it would be accepted. "Obviously it would depend on the terms but I think it would have a very, very good innings."
Dr Daly contrasted his narrow defeat in Killarney with a "packed and passionate" extraordinary general meeting of the IMO in Portlaoise in 1997, when his proposals for a free GP service were "thrown out totally".
A measure of the change in opinion is that a key opponent on that occasion now supports him. Dr Cormac MacNamara, an influential former president of the IMO, has explained to The Irish Times that in Portlaoise he thought the timing wrong - that "we could not call for extension of a scheme which we thought inadequate". He supported Dr Daly's motion last weekend "in the context of the primary care strategy".
"If there was a comprehensive national health service, provided it was adequately funded, the vast majority would be happy to subscribe to it. For me personally and, I suspect, for the majority of doctors in the IMO, in principle a free GP service would hold no fear. Our priority is to have a system with properly trained doctors with appropriate resources."
Whereas Dr Cyril Daly considered it "would bother very few GPs now if they were salaried", Dr MacNamara suggested that GPs' income should have some recognition of productivity. However, he said that GPs were coming to see their method of payment as less important than its adequacy.