EDITORIAL: Minister must win over GPs

CONCLUDING his speech to the recent Irish Medical Organisation (IMO) conference in Killarney, Minister for Health Simon Harris, declared: ‘Together we can build a better health service. We know what we need to do. Let’s get on and do it.’ Which must have left delegates rather nonplussed, to say the least.

Members of the IMO and also the more militant National Association of General Practitioners (NAGP) are justifiably fearful that restoration of their fees that were cut when the Financial Emergency Measures in the Public Interest (FEMPI) were introduced during the economic downturn will come at a price of extra duties and responsibilities being imposed in return. Formal talks on a new GP contract are imminent, but doctors generally are in no mood to be taken for granted, given the low morale that exists among general practitioners who are trying to keep a service that is in crisis going.

They claim that FEMPI has exacerbated an already under-resourced service and has led to young, highly-trained GPs emigrating and many experienced, well-respected GPs to retire early. At last month’s NAGP annual general meeting in Cork, its national president, Dr Emmet Kerin pointed out: ‘We are now seeing a broken health system nationwide where new patients are unable to sign on to GP practices as they are beyond capacity. Here in Cork, Macroom is completely closed to new patients.’

The NAGP is also seeking negotiating rights for the new GP contract if its members are to sign up to it, which should be the case given that it represents more GPs than the IMO does. The Department of Health and HSE are negotiating a framework for the contract talks with the IMO, the NAGP only being brought in on a consultative basis. 

The current GP contract is 40 years old, so a new one is badly needed, as the Minister for Health said, to meet the needs of patients, general practitioners and the State, while providing for better health promotion, structured care and disease prevention.  

The carrot that Minister Harris dangled before the GPs at the IMO conference is that ‘there is now the potential for general practice to secure significant additional investment in the coming years.’ Acknowledging that ‘this is much needed,’ he did not deny that it will come at a price, as the Department of Public Expenditure and Reform is seeking value for money, and that the upward revision of fees will have terms and conditions attached as they move into what he described as ‘a post-FEMPI era.’ 

It was not the signal that the majority of doctors wanted to hear from the Minister and it made his exhortations to them about working ‘together to reach higher terrain’ ring hollow and seem patronising – maybe even a tad naïve. Primary care in the community is their field and the reality is that the country needs about half as many more GPs and practice nurses as we currently have if it is to be sufficiently-enough resourced to meet the vision for it in the commendable cross-party Sláintecare report, which outlines the key building blocks the Minister needs to work with on reforming our badly-broken public healthcare system.

There are commitments to building capacity with more capital investment, recruitment and retention of staff, and reducing waiting lists for treatment. Last week, Minister Harris announced a welcome In-patient/Day Case Action Plan, designed to reduce the overall number waiting for operations to under 70,000 by the end of the year – from a peak of 86,100 in July 2017 – however even the size of the reduced waiting list will still be totally unacceptable.

He is planning a similar initiative to tackle the even bigger outpatient waiting lists, but again they will remain huge afterwards and the suffering for most of those affected will just go on and on. The Minister will need all the help he can get, especially from GPs, who are the fulcrum of the entire healthcare reform effort, so the new contact talks are even more crucial.