Primary Care Minister Alex White has repeated his call for 'talks about talks' with the Irish Medical Organisation on the controversial plans for the provision of free GP care for all children under six.
The Minister, who adopted a largely conciliatory approach when he addressed an angry audience of around 350 GPs at the IMO AGM in Co. Kildare today, said it was intended have the legislation on the new scheme enacted by July.
The Minister hinted that there may be ways of dealing with the impasse caused by the Government's ban on direct negotiations on fees with the IMO and said controversial contract proposals which have angered GPs were not a 'fait accompli'.
GPs at the meeting expressed anger at what they believe is an unworkable and restrictive draft contract on the scheme, and at recently published draft legislation, which they say copperfastens the Minister for Health's right to set GP fees and to cut them further.
Minister White told the meeting it was highly unlikely that the fees of GPs or other State workers would be cut any further under Financial Emergency Measures in the Public Interest (FEMPI) legislation.
He said the Bill was not 'FEMPI 2' and its provisions on the Minister's right to vary fees paid to GPs had been misinterpreted.
IMO GP Chairman Dr Ray Walley told the meeting that GP income had already been cut by 38% in recent years while income elsewhere in the public sector had been cut by around 18%.
He called on the Minister to enter into real negotiations on the scheme, and said the Competition Authority's stance that GPs could not negotiate and agree fees, which is being followed by the Government, was wrong.
GPs at the meeting said they do not have the resources to take on extra under sixes patients.
GPs are also angry at provisions in the legislation which mean that doctors who do not sign up to the new deal stand to lose their existing under sixes medical card patients, a move that GPs have warned could cause chaos for patients.
The IMO is insisting that it should have the right to directly negotiate fees for the new scheme with the Government, which say this is technically not possible under competition law. The legislation states that while consultations can be undertaken on fees, the Minister ultimately must set fees.
Minister White, however, indicated that there may be room for flexibility on how the fees issue could be addressed. He told the meeting that negotiating restrictions under competition law 'should not be overplayed'.
He said the question of shifting resources to general practice could be dealt with when the next Budget Estimates process gets under way.
He proposed that talks should take place with the IMO on how the two sides can engage on the under sixes scheme and what the agenda for talks should be.
The Minister said the two sides could can table items they wanted to discuss, for example resourcing for the new scheme
Mr White said he would not be setting any preconditions for this agenda-setting meeting, which offered the best hope for the two sides to move forward.
However, as regards the ban on direct fee negotiations, he said he could not depart from the clear advice he had received on competition law.
The IMO has stressed that a former attorney general, Paul Gallagher, has claimed the Government's interpretation of the law as regards fee-setting for independent contractors is wrong.
A legal case on whether or not the IMO has the right to negotiate and agree fees on behalf of its members is due to be heard in the High Court on May 21.
Minister White said the legislation gives the Minister the ultimate authority to set the fee, but all issues in relation to an under sixes GP contract were subject to negotiations.
He said there was a huge amount that could be achieved, even within the constraints of competition law. He said everything to do with the future of general practice in the context of primary care was a matter for negotiation.
"The only issue is the final setting of the number of the fee, which has to be a matter for the Minister, and that leaves huge scope for negotiation," the Minister told reporters after attending the GP meeting.
He said he wanted to address the difficulty with the IMO about negotiating fees, and he wanted to address that with the union across the table on a without prejudice basis.
During the debate, GPs claimed that the Government was using money saved through taking medical cards off sick and vulnerable people to fund a scheme which would treat the children of well-off people free of charge.
Minister White denied that this was the case.
Co. Galway GP Dr Martin Daly, a former IMO President, told the meeting he was 'nauseated' at the Government's policy on this. He said medical cards were being taken off children with Down's Syndrome and would be given to well-off people.
Minister White defended the Government's policy of introducing universal access for all to free GP care, pointing out that Ireland was one of the few developed countries that had restricted access on financial grounds to such care.
He said no child, rich or poor, should be denied access to their GP.
The Minister agreed that removing medical cards from people who needed them and giving them to well off people was wrong 'but we are not doing this'.
He said the €37 million being provided for the under sizes scheme this year was 'new money'.
Another former IMO President, Dr Henry Finnegan, claimed the Government could remove the competition law difficulties over fee negotiations by changing the law.
Mr White, however, claimed that it was not as simple as that, as Ireland was also bound by EU law on this issue.
Asked what contingency plans the Government had in place should a large number of GPs refuse to sign up to the new scheme, Mr White said the Government was 'way off' contingency plans at present. He said the draft contract on the scheme was a 'work in progress' and not a fait accompli.
"I earnestly wish that we can now have a process of real engagement with the IMO."
While GPs at the meeting were angry at the Government's policy on the under-sixes scheme, the Minister was not heckled or interrupted, although he was not applauded following his address.
Govt should get real with GPs
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