Dr Sean McGuire's unexpected departure from the HSE raised many eyebrowsDr Sean McGuire, the man who went from advising the chief executive of the HSE about primary care one minute to advising a private company building primary care centres the next, spoke about his move to Health Correspondent Eithne Donnellan
Just 18 months ago the Carlow-based GP, Dr Sean McGuire, won a lucrative contract to advise the new chief executive of the Health Service Executive (HSE), Prof Brendan Drumm, about how primary care or community-based health services should be improved.
As a doctor who had spearheaded the setting up of the first out-of-hours GP co-op in the State, his expertise was welcomed by the HSE and in return he was offered €202,500 for working 135 days a year.
So when the HSE suddenly announced just over two weeks ago that he was departing the organisation, many eyebrows were raised.
There had been some suggestions he was involved with a private company called Touchstone, which plans to build 60 primary care centres across the State, at the same time as he was advising Drumm.
However, McGuire vehemently denies this, saying his only involvement with Touchstone prior to joining its board of directors last month was as "a customer" interested in buying a suite for his Carlow GP practice in a primary care centre Touchstone was planning for his town.
The discussions with Touchstone about this suite began even before he joined the HSE, he says.
"The GPs in Carlow asked Touchstone . . . I wasn't even at the first meeting . . . down to actually explain their model and then a couple of those practices, one of which was my own, then proceeded to actually go and look at signing up to buy suites," he says.
Any suggestion he was involved with advising Touchstone in the past is "absolutely rubbish", he contends.
"I never did any work for Touchstone." There was no conflict of interest, he insists.
He says he left the HSE as his role in kick-starting back to life the 2001 primary care strategy was complete.
"Most GPs felt the primary care strategy was dead . . . and so my role was to get that moving again and that is what has happened now, in that the Irish Medical Organisation has now recognised that primary care teams are the way forward.
"All of the unions have recognised that and that is enshrined in the Towards 2016 document," he says.
While a number of primary care teams are being set up, none is actually up and running yet, so surely his work with the HSE wasn't complete?
"It is down to the executive to implement this . . . it's down to implementation. My role was never in implementation . . . I wasn't a HSE employee, so I wasn't in line management.
"I was just an adviser so therefore I could not be directly involved in implementation," he responds.
"I could still have contributed in a reduced fashion. In other words I was contracted for about three days a week . . . I had now gotten to a stage where the advisory role would have been about one day a week," he says.
But the public assumed he would remain with Drumm for his five-year term.
"I had a contract which allowed me to be there for the five years but it was always a situation whereby it was however long it took to get the various things in place," he says.
There was no penalty clause when he left before the five years were up, he adds.
"It wasn't that this had to be for five years, this could be ended by either party . . . there wasn't any penalty clause if you leave early, there was nothing like that because if there was I probably would never have gone into it.
"I never viewed it as a situation where my contribution would require five years," he added.
"I certainly wasn't pushed. It was entirely my own decision [ to leave the HSE], having discussed it with Brendan Drumm," he says.
He says he got on well with Drumm and Drumm's other advisers. "I would regard them as being close friends and still are and hopefully will always be."
A father of two and originally from Ballyhaunis in Co Mayo, he stresses that going into Touchstone now is merely "a continuum" of what he was already at - trying to put in place better primary care services.
"A big problem facing primary care teams is where are they going to locate . . . and Touchstone is one of the solutions to that."
He says Touchstone plans to build centres which will have GP suites that will be bought out and owned by family doctors, while other space in the centres for physiotherapists, pharmacists, dentists, diagnostics, home helps, public health nurses and so on could be leased by the HSE or by paramedics themselves.
The premises will be of "four star" quality, he stresses.
As regards suggestions that this will lead to further privatisation of the health service, McGuire says the vast majority of primary care infrastructure or GP premises is being provided privately at present, by GPs themselves.
"What this is doing is allowing GPs to actually have premises which are much more suitable to their patients so that patients no longer have to be going into dingy waiting rooms . . . instead of that patients are going into state-of-the-art infrastructure . . . this is bringing primary care into the 21st century . . . there is no privatisation there," he says.
"It's not like saying 'oh we've got all these beautiful public community centres around the country and they're going to be now privatised'. They don't exist.
"Primary care infrastructure at the moment around the country . . . most HSE infrastructure is of a poor level at the moment around the country. You have many HSE staff who are working in abysmal circumstances.
"You have a lot of GPs who are in premises which aren't appropriate," he says.
McGuire contends that many GPs would not take the financial risk of building their own primary care centres - there are no tax breaks for them - and if the State poured billions into building them, GPs, like in the UK, might opt out as a result of having no sense of ownership of them.
"At the moment there are over 300 GPs involved with Touchstone, in other words in discussions with Touchstone on their options.
"My role is facilitating those discussions," he says.
The company plans to spend around €800 million over the next few years on building primary care centres.
The man behind Touchstone is Fergus Hoban, who was one of the main shareholders in the Unicare pharmacy chain that was sold to German operator Gehe in 2002 for an estimated €145 million.
McGuire acknowledges that progress can be slow in the public sector.
"In the private sector you can make a decision and you can act on it very quickly. In the public sector you take a decision and then you have to see if you can bring everybody with you and that is the process. That can be difficult."
Is that what tempted him to join Touchstone?
He laughs. "What tempted me to do this job was that I felt I had contributed as much as I could contribute from an advisory point of view in the HSE."
The Irish Medical Organisation's GP leader Dr Martin Daly, as well as the health spokespeople for the main Opposition parties, Fine Gael's Dr Liam Twomey and Labour's Liz McManus, say there should have been a "cooling off" period between his two jobs.
McManus says if this was in the US, McGuire would have to wait five years before joining Touchstone.
When asked about this, McGuire looks taken aback. "And me be unemployed in between?" he asks.
Twomey is also concerned that the HSE said when McGuire left that his work was done. He believes this simply isn't the case.
And he says official State ethics legislation should cover top-level policy advisers brought into the HSE and it does not.
McManus agrees. And she fears that all the new privately funded primary care centres will lead to the "corporatisation" of general practice.
"I would be extremely worried if we ended up with primary care teams in centres owned by just one company," she says.
The health service is now vulnerable to private "predators" interested in making lots of money, and regulations to prevent this are non-existent, according to McManus.
Meanwhile, the HSE refuses to say for definite whether it will or will not hire space in or services from the new Touchstone centres.
It says it operates in accordance with strict procurement regulations that are open and transparent.
"These regulations mean that, where possible, proposals and tenders would be invited from all interested parties.
"These proposals would then be assessed against a series of predetermined criteria including value for money, the involvement of local GPs and their suitability for supporting the development of primary care teams.
"After this competition and a comprehensive assessment process, the HSE could enter into an arrangement with any potential facilities provider," it says.
"The HSE envisages that the infrastructure for the planned 500 primary care teams, which will be guided by a standard template, will be developed in a number of ways.
"In some situations the HSE will build facilities and make them available to local primary care teams.
"In other situations it may be preferable to lease facilities from the private sector for the primary care teams," it continues.
Daly says progress on the rollout of primary care teams is being made but the "unexpected departure" of McGuire has created "a lot of uneasiness" among GPs.
"His departure raises many questions which will need to be answered to re-establish confidence amongst GPs in this process," he says.
"I think we do need to know how far back has he had a relationship with Touchstone. One of the other questions would be were the HSE aware that McGuire had begun a commercial relationship with Touchstone before it broke in the news?"
Meanwhile, Daly argues that in the absence of Government funding there should be tax incentives for GPs to develop their own primary care centres "which would allow a diverse ownership of primary care infrastructure rather than having it concentrated in any one group or corporation".
The IMO's advice to doctors, Daly says, is to take very good legal advice before becoming involved in any private corporation.