Ian McGuinness spoke to incoming IMO President Dr Martin Daly about his dissatisfaction with the ongoing problems regarding the GP contract. The Irish Medical Organisation (IMO) will use legal means, if necessary, to assert its right to represent general practitioners, the outgoing Chairman of the union’s GP Committee has announced.
Dr Martin Daly, who is also the incoming President of the IMO, said it has contacted its GP members to explain the ongoing impasse in relation to contract negotiations. He said: “The HSE has taken the view that the IMO can’t negotiate collectively for general practitioners. However the IMO asserts its right to represent general practitioners in negotiations with the State and intends to assert this right by any means, including legal means.”
h4. A third party
Dr Daly said the Minister for Health, Mary Harney, stated some months ago that she recognised the right of professionals to be represented on contractual matters. Pointing out that she suggested a third party could be established to set fees, Dr Daly said: “The IMO would encourage the Minister to expedite the undertaking to do that.” The Galway GP said the Minister should instruct the HSE to start negotiations with the IMO, while both sides are waiting for the establishment of that third party.
The GP Committee Chairman contrasted Prof Brendan Drumm’s stance with that of Minister Harney: “It is clear to the IMO that they are taking different positions. The Chief Executive Officer of the HSE has stated that the HSE is currently designing a new GP contract. The implication is that they would be designing it and pricing it.”
Dr Daly said Prof Drumm’s views are at variance with Minister Harney’s. “The idea that the HSE would be able to design a contract enticing GPs and patients is not sustainable,” the IMO negotiator said.
However, the incoming President also flagged up concerns, which some doctors have, that the HSE could use the establishment of primary care teams to alter contractual arrangements with GPs at a local level. “Any attempt to undermine the current GMS contract will be resisted on behalf of GPs,” he said. Dr Daly explained: “The IMO has engaged Towards 2016 in writing up an agreed document, based on partnership, and as a guide to rolling out primary care teams.” He also said that it was not clear whether the HSE will fund the roll out of the teams, given that the recruitment embargo has paralysed the establishment of new ones.
Another issue that is complicating the negotiation of a new GP contract, and which has become an issue in itself, is competition law. The question has been raised by the employers’ side as to whether or not such legislation allows for negotiations with unions when they are representing independent contractors collectively on remuneration issues.
Dr Daly said: “The IMO will always act within the law and is obliged to do so as a responsible organisation and union, and that includes competition law. It is the view in some quarters and among our members that the HSE is using the Competition Acts as industrial relations leverage. If that is the case, it would be reasonable therefore to say the HSE is abusing its dominant position as a purchaser of health services.” He said that while some lessons may be learned from what is happening to the pharmacists, there is a different contractual relationship between GPs and the State, in comparison to that between chemists and the State.
Turning once again to the issue of primary care teams, Dr Daly addressed the buildings needed to house such groups. “It is clear the HSE, the Department and the State have taken the view that they will not be responsible for the infrastructure under the Primary Care Strategy,” he said.
h4. Invited tenders
The HSE recently invited tenders from individuals and groups who were building, or had built, health structures and who might be interested in leasing part of these to the HSE for the provision of public primary care services. Dr Daly pointed out that the HSE also wrote to GPs inviting them to express an interest in such contractual arrangements. He said a deadline of early March was given to doctors to do this.
“Our concerns revolve around the short time-frame of announcing the model and the closure of submissions, as it is favourable to third party developers and health care providers,” he said. However, Dr Daly pointed out: “None of these projects or developments can progress without the involvement of a critical mass of local GPs.”
The IMO has advised GPs who are considering such involvement to take legal, accounting and estates advice. While the issue of primary care teams looks set to become more prominent in the media, out-of-hours GP co-ops have fallen off the radar somewhat. So, what is going on? Pointing out that there are still parts of the State that are not covered by such bodies, Dr Daly said some doctors decided not to join existing co-ops but a smaller number of doctors have no access to such services.
The GP Committee Chairman said that co-operative structures must be developed in the context of a new GP contract. He said that a template is needed for the development of co-ops, but one that will allow flexibility at a local level.
Dr Daly pointed out that many GPs still fund red-eye shifts from their own pockets and he noted: “It is becoming a major source of frustration and anger for our members.”
Referring to the co-op agreement covering north Dublin, the incoming President added: “It would appear, after completing 18 roadshows up and down the country, that many GPs would be satisfied to have that model in their area.”
It seems, from what Dr Daly said, that progress on a number of significant general practice issues depends on GP contract talks resuming and being successful.
About Gary Culliton
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