IMO rejects CA view of negotiating entitlements

The IMO believes the CA is incorrect regarding its negotiating powers, writes Aoife Connors

The IMO has rejected the claim from the Competition Authority (CA) that the existence of the GMS contractual relationship between the IMO and the Minister for Health has been one of the key impediments to reform of the medical card scheme.
Last week (July 9), the CA published Part III of a series of reports into general practice, entitled ‘Increasing Competition within the General Medical Services (GMS) system’.
The report states that implementation of the various recommendations made in the report would be “complicated” by the fact that changes in the GMS contract require amendment of the agreement between the IMO and the Minister for Health.
Effectively, the IMO must agree to the implementation of the recommendations first.
Dr Ronan Boland, IMO Vice-President and Chair of the IMO GP committee, told Irish Medical Times that he rejected the CA’s view on the IMO’s negotiating entitlements. “The IMO has an entitlement to appropriate representation and collective engagement with the State. That entitlement was recognised by the Government in December 2008, when it agreed to amend the Competition Act.”
In its report, the Authority suggests it may be easier and more effective to terminate the existing contract and begin “a new contract afresh”, rather than attempting to amend the existing agreement.
Competition between GP practices is restricted by certain features of the GMS system, the report states, as it favours existing practices and discriminates against newly-qualified GPs. Both public and private patients are affected by competition restrictions, because the CA says there is less pressure on GP practices to compete on price for private patients. There are also fewer GP practices from which to choose.
The CA has directed five key recommendations to the IMO, the HSE and the Minister for Health. The Authority has recommended that access to GMS contracts should be open to all qualified and vocationally trained GPs that meet general suitability criteria. GPs in possession of a GMS contract should be free to set up in, or move to, the location of their choice and the decisions to award a GMS contract in an area should not have to take account of the ‘viability’ of existing GP practices in the area, the CA recommend.
Dr Boland rejected these proposals: “It costs the State and the taxpayer a lot of money to produce a fully trained GP and, quite rightly, the State has maintained a stakeholder position in terms of the distribution and location of doctors. So while the individual doctor’s preference in terms of location is important, there is also a healthcare system to consider and for that reason, the IMO and I would not be in favour of complete deregulation.”
He told IMT that it was the IMO’s view that open entry to the GMS, allowing doctors GMS contracts in areas of their choice, would not be in the best interests of the GMS as a whole.
Dr Boland highlighted that in many parts of the country, there was a significant manpower shortage: “It’s difficult to get doctors. The manpower shortage is likely to continue in the medium- to short-term and, in a situation where you allow practices to be created in the location of their choice, historic experience has shown that doctors tend to gravitate towards more affluent, urban areas. This exacerbates the difficulties of getting doctors to work in less-advantaged areas.”
Surveys showed that doctors had a preference for working in a group-practice setting in an urban area and complete open entry would facilitate that, he said.
The CA has also recommended that the marking system for awarding GMS contracts should be amended to ensure applicants with similar levels of GP experience are awarded equal points, and that applicants already in possession of a GMS contract are not treated more favourably.
Finally, the Authority believes that payments to GPs under the GMS should be decided not on the basis of agreement with the IMO, but by the Minister for Health, following consultation with GPs and/or the IMO.
Dr Boland said: “This is no longer valid as the Government announced in the Public Service Agreement [Croke Park deal] that further discussions will take place with the Irish Medical Organisation — in relation to the Government’s commitment to make appropriate changes to Section 4 of the Competition Act 2002 — to enable the representative body of GPs, the IMO, to represent its members in negotiations with the HSE and the Department of Health in respect of the services provided to the public health service in a manner consistent with the public interest.”