After last weekend the Government should be in no doubt as to the depth of opposition among family doctors about its plans for the introduction of free GP care for children aged under six.
More than 350 GPs from around the country turned up for a special session of the Irish Medical Organisation's (IMO) annual conference, which was attended by Alex White, the Minister of State at the Department of Health with responsibility for the plans.
For nearly two hours White dealt calmly and confidently with questions and concerns raised by doctors who were angry but polite. There was no heckling or booing.
However, at the end there was certainly no meeting of minds.
For the Government the provision of free GP care is a key commitment and is one of the main foundation stones for its more ambitious plan for universal health insurance.
However, the longer the row continues over the first stage of the plan – free GP services for children under 6 – the greater the doubts that the Government can achieve its target of having free GP care for everyone by 2016.
Reasons
It was quite clear that GPs have various reasons for opposing the Government's plans.
GPs run independent businesses providing services to the State under a contract. They are not employees of the health service, and many are fearful for their future livelihoods under the planned reforms, particularly coming on top of nearly €500 million in cuts over recent years.
Many suspect the fees eventually set for the scheme would not match their existing earnings from private patients, and there are fears proposals that their State contracts would have to be renewed every five years would undermine their business model.
There are also worries that their practices could be overwhelmed if families given a free service opted to attend more frequently.
Other doctors are concerned that the Government is planning to give medical cards to healthy children while children with discretionary medical cards are losing them on foot of HSE reviews of their parents’ financial means.
White insisted that the funding for the free GP care initiative was "new money" from the exchequer and not simply a recycling of savings from the cancellation of the discretionary medical cards. However, many in the audience were in no mood to believe him.
Problems
For GPs the problems are compounded by the Government's insistence that it cannot negotiate with their trade union on the fees to apply on competition grounds as they are contractors.
White argued that he wanted to negotiate on all aspects of the contract for the scheme and would “stretch and stretch the Government’s room to manoeuvre” but the actual setting of the fee rates had to be a matter for the Minister.
The meeting also showed that after the cuts of recent years, the culling of discretionary medical cards and rows over payments, many GPs have little or no trust in the HSE.
A draft contract published several weeks ago, which contained a “gagging clause” to protect the reputation of the HSE, infuriated many doctors.
White has called for talks about talks with GP representatives at which a process for agreeing an implementation plan for the scheme could be hammered out.
The IMO is expected to reply to the Minister later this week. In the meantime, uncertainty about the Government’s plans for free GP care continues.
