Urging doctors to join the “only trade union” for medical practitioners, new IMO President Dr Peadar Gilligan tells Lloyd Mudiwa if only the Government could keep up with it, Ireland would have a far better health service
Emergency medicine consultant, Dr Peadar Gilligan felt “very lucky” to take up the Presidency of the Irish Medical Organisation (IMO) at a time when it was growing in strength.
On the back of a successful AGM held in Killarney, Co Kerry last month, the new President told Irish Medical Times his Organisation had a “very active” group of people involved in its Council and Committees, and “strong chairs” of its Committees.
“With regard to the Organisation itself, we have had a period of time where we have re-examined and updated as appropriate, the structures of the organisation, standing orders and the rules and off course that can be informed by the IMO AGM as well, through the IMO Council and the Executive,” he said.
Dr Gilligan said: “I think the governance structures, we are pleased with currently. We would certainly, like every organisation and representative body, love to have more doctors joining.”
One of the issues for Irish doctors in general was the number of associations now representing or engaged in the representation of doctors, “but we are the only trade union for doctors,” he claimed.
“So it’s very important I think, as I have told many people. I myself am a member of two colleges, a fellow of another, a member of a specialty association, but off course, I am also a member of the trade union that represents doctors, which is the IMO.
“I would be very keen to see our membership grow during my Presidency because as I said in my inaugural address (at the AGM), the collective bargaining is how we help to improve things for doctors and our patients.”
One of IMO’s strengths, he said, was that it realised the implications of each policy change for every doctor working within the health system.
“I am absolutely confident in saying that the IMO is the only organisation positioned to have that level of awareness of the impact across the system of policy,” he commented.
He exuded pride in the policy work the IMO do. The IMO, he highlighted, had been involved in the informing of health policy for several years now. “As an organisation, we always give considered opinions with regard to issues of importance to patient care and to doctors and we spend a lot of time, in the secretariat, in the preparation of policy documents, and in engagement with doctors and our members and their concerns that also inform those policy documents.
“I have no hesitation in saying that we do better than any other representative organisation of doctors currently in the country.”
The Government often suggested trade unions were regressive, he said, but motions at their AGMs over the years showed the IMO had been addressing the need for the development of trauma care, and the expansion of doctor numbers etc. “Rather than being regressive, we are incredibly progressive — and if Government could keep up with us we would have a far better health service.”
Access to care
According to Gilligan, access to care was one of the major issues, some of which had been raised at the AGM, for every doctor in Ireland across all craft groups and specialties.
Dr Gilligan told IMT surgeons nationally were “hugely frustrated” because they could not get to operate on their patients because of ongoing theatre closures; while anaesthetists and intensive care specialists were “very concerned” they could not get patients into their intensive care units in as timely a manner as they would like.
Emergency medicine doctors working lives were also increasingly challenged by the degree of crowding of hospital emergency departments (EDs), which again was a capacity issue, he said.
“We now know we have more than 500,000 patients on a waiting list nationally and that’s definitely a function of the capacity challenges in the system.”
On the repeated used of the phrase “it’s not just about beds” in the recent appearance of the PAC Consulting’s team that drafted the Health Services Capacity Review before the Joint Oireachtas Health Committee, Dr Gilligan remarked: “My concern is whenever that phrase comes up, it means we are not going to see the progress that we need to see in the bed aspect of things.
“And I absolutely concur, it’s not JUST about beds; but it mostly certainly is about beds and it mostly certainly is about staffing those beds. So we need to start building that capacity.”
Touching on the main issues affecting doctors emerging from the AGM, he said “a very significant concern” was that the current general practitioner (GP) contract was unfit for purpose with GPs finding it difficult to fill General Medical Services lists nationwide.
“I was talking to a colleague whose father was only able, very recently at 74 years of age, to stop practising, after finally finding somebody who was willing to take over his list on a part-time basis. That’s echoed around the country for GPs where there is difficulty for them in getting replacements at retirement, when taking annual leave, and when sick.”
Dr Gilligan said family doctors had made very significant efficiencies within their practices, in the context of 38 per cent Financial Emergency Measures in the Public Interest (FEMPI) cuts, which resulted in them having less resources to deliver care to increasing numbers of patients and with higher visitation rates as a result of the under-sixes free GP care contract.
‘Same room’ negotiations
Pushing for new GP contract negotiations in “the same room”, the National Association of General Practitioners (NAGP) has said a three-way process involving separate engagements between the health employers and the IMO, on the one hand, and itself, on the other, was delaying progress on reaching a deal.
Dr Gilligan responded: “We are a trade union. If people want to influence our decision-making, they need to be members of this trade union which is the IMO.
“We are very happy for people who are in the NAGP to join the IMO and help us progress issues, but it will be as members of this organisation that they will be engaged in those discussions.”
Among the many reasons GPs should join, the President said the IMO had in excess of 30 years of experience in industrial relations and a wealth of individuals involved in contract negotiations for many years now capable of delivering the contract.
With various bodies that seek to represent doctors in negotiations, there can be a perception that there are divisions evident among the doctors, and that division can be used against doctors, he concurred.
“The IMO does have a very clear concept of what the GP contract needs to address and I am not sure that that’s necessarily the case for other associations.”
At the time of interview, the IMO had not yet received a date for the resumption of contract talks previously planned to resume last month.
“No, and that is causing significant concern. Our GP Committee is ready, willing and able to engage with the Health Service Executive [HSE], and the Departments of Health, Public Expenditure and Reform, and Finance to address the issues and they do need to be addressed quickly so that we can retain the doctors who are in training as GPs in Ireland as well as those GPs already working,” Dr Gilligan said.
“We are confident that the Minister for Health will deliver on his commitment made at the AGM in that regard, and I hope that our confidence is borne out.”
With regard to non-consultant hospital doctors (NCHDs), there remained concerns around them not being given their contractual entitlements, paid for working overtime, and allocated their study time.
Compliance by hospitals with the European Working Time Directive (EWTD) was also a challenge.
He said: “When we tried to become EWTD- compliant, we didn’t increase the level of medical staffing commensurate with the loss of working hours to the system, which compliance with the Directive meant, such that doctors now find themselves trying to deliver outpatient clinics, for example, with little or no members of their team present because they were working the previous night and, therefore, have gone home.”
He said it would also be false to suggest the entire country and all doctors were EWTD-compliant, because the IMO knew they were still post-holders countrywide working in excess of the stipulated hours. The IMO would like to see further progress on compliance and staffing of NCHD positions.
Consultants’ pay cuts
There was a sense that Community Medicine and Public Health doctors (PHDs) were not as valued by the health system as they would like to be. PHDs undertake specialist training in public health and feel they deserve a consultant contract, consistent with other specialists’ contracts.
The 30 per cent pay cut for new-entrant consultants employed since 2012 meant they were paid less than colleagues employed earlier.
“It has really upset a lot of doctors,” Dr Gilligan said. “It has very negatively impacted on our ability to recruit to consultant positions nationally, and I am aware of colleagues abroad, who have made it very clear to me that they are not coming back until that issue is addressed.”
That issue, coupled with the failure to honour the consultant contract of 2008 and forcing consultants to take legal action to have the contract honoured, had a “really significant” effect on consultants’ morale nationally, he mentioned.
“What the HSE will tell you is there are now more consultants in the Irish health service than ever before… even though the number of vacant posts is greater than ever before,” Dr Gilligan said.
He added: “Our concern as an organisation is that not only do we have 450-plus vacant consultant posts around the country, we also have some of these hospital posts filled by doctors who are not on the specialist register of the relevant specialty.”
This meant the strategic development of services and provision of specialist services was inadequate, he said.
Putting an argument to bed
Congratulating the Minister for “absolutely and finally” putting to bed the argument that we need more beds in the acute hospital system, Dr Gilligan was hopeful they would now be delivered.
He said: “That absolutely means that as a starting point we need 2,560 acute care beds. That is just to address some of the requirements of the system because PA Consulting made it very clear within the Sláintecare Report that they did not have the necessary information to know what the capacity requirements of the unmet health needs in the country were and they are huge unmet needs.
“So when we increase the capacity in the system — as we found with the under-sixes free GP care — we are going to find that while we are in a position to provide more care, there will still be a requirement to provide significantly more care.
“If Sláintecare’s proposals that nobody should be impoverished in their accessing of healthcare, and that healthcare ideally should be free at the point-of-care are to be delivered, undoubtedly the visitation rates for all practitioners are likely to markedly increase; our additional capacity even at 2,560 beds would be inadequate,” Dr Gilligan added.
There would also be a need for more nursing, medical and associated healthcare professionals staffing.
He pondered: “Is it realistic? I think the reality is it has to happen.” He said Ireland, historically, and for most of his career, had invested less in the provision of healthcare than most other Organisation for Economic Co-operation and Development [OECD] member countries.
Despite improving to above the OECD average in recent years, there were significant numbers of people making out-of-pocket and private health insurance contributions.
“The reason that 47 per cent of people in Ireland are paying for private insurance is that they are terrified of not being able to access care when they need to. Certainly by providing capacity, we help to address that terror for patients and help doctors to provide the care that they want to,” Dr Gilligan said.
Doctors in Ireland, he pledged, did not want to squander the opportunity to improve the health service “very significantly”. But Dr Gilligan said it was really important that the health service also facilitated the realisation of this opportunity Sláintecare represented, so that “we have a health service that we can all be prouder of”.