There has been little sign of the Government's promised radical reforms of the health service over the last year, the outgoing president of the Irish Medical Organisation (IMO) has said.
In an address at the opening of the annual conference of the doctors' trade union today, Dr Ronan Boland also expressed scepticism that the Government will implement its planned new system of universal health insurance within the timescale it has set itself of during the course of a second term in office.
He said while there had been some changes in goverance structures at corporate level in the health service over the last 12 months, at the coalface it was a case of "as you were".
He said there were more patients, more procedures, fewer beds, fewer staff and fewer resources.
He said if radical reform was at hand it felt little closer than it did when the IMO last met in conference a year ago.
Dr Boland said it was perhaps telling that the number of invitations to discuss universal health insurance had lessened as the last year went on, "persumably as realisation grew that Rome will not be built in a day".
"A country on the brink of insolvency is not in the best position to fund dramatically improved access to more and speedier health care, irrrespective of who is writing the cheque."
Dr Boland said there had been no transformation programme for general practitioners. He said there had been no movement by the Government in honouring commitments it had made repeatedly in relation to changing competition law. Official interpretation of existing legislation in this area is that the IMO cannot negotiate with the State in relation to fees for GPs on the basis that they are independent contractors and not employees.
"The only solution to the current impasse is one which guarantees in law the protection of this organisation in its unencumbered representation of general practitioners in relation to their work carried out on behalf of the state. Until the Government recognises this and takes the appropriate action, progress on any reforms involving general practice will be difficult if not impossible."
Dr Boland said some progress had been made on the implementation of the Croke Park agreement for consultants, non-consultant hospital doctors and public health doctors, but that real challenges remained.
"Contracts continue to be flouted and recruitment and retention of medical expertise in Ireland becomes ever more difficult."
Dr Boland said during his year as IMO president he had urged the newest doctors, where possible, to stay in Ireland and help build a better health service.
However he said if the latest reports were to be believed, "more than half of the new doctors I addressed are already booking their one-way tickets to Australia, New Zealand and Canada".
"Much in our system still needs fixing."
