What now for general practice after the Budget?

Minister for Health Leo Varadkar

So the Budget has come and gone and there has been no major transfer of funds to primary care or general practice, or even any firm indication that it will happen any time soon. This is exactly as I predicted here, but for those who are struggling to make a living as general practitioners, it is not yet a case of ‘abandon hope all ye who enter general practice’.

Yes, the arguments have been well made, and the practical case for siphoning a little bit of the flood of money towards a cheaper, more effective primary care service has not been acted upon, so it might seem – on first impression – that Minister Varadkar is cut from much the same stalk as Minister Reilly. It might seem that he is as intent as Minister Reilly was in maintaining the status quo.

But that assumes that Leo Varadkar, who has succeeded in both medicine and politics, is, in fact, working with the brain capacity of the average TD (member of the Irish parliament) when we all know that he is not. So it’s a bit of a conundrum then, is it not, that Leo seems to have ignored the crisis in general practice, the deprivations of rural and older patients, and the growing emigration of GPs of all ages from all parts of the country?

But doctors tend to think like doctors, and when they meet a fellow practitioner, they tend to think alike. And this is the mistake that GPs are now making about Minister (Dr) Varadkar. The fact that he is a doctor is not what is uppermost in his mind – indeed, I’m sure he is careful to weigh that fact conservatively in his deliberations so that he doesn’t think too much like a doctor. No, Leo is now thinking like a politician, and that’s what should give doctors hope, ironically.

The reason the Minister did almost nothing to resolve the crisis in general practice is because he still needs something from Irish GPs, and he hasn’t got it yet. From a doctor’s point of view, when they see a situation that is bad for themselves and their patients, they think they should change that as soon as possible. But Leo is not thinking like a doctor (even though he can understand the thinking and would like to help), he’s thinking like a politician, and a successful one at that.

So why didn’t he even make a nod towards the problem? Why didn’t he respond to the 300 doctors that gathered outside government buildings just a few weeks ago?

The answer is that Leo wants something. Strike that, Leo still needs something from doctors, and that thing is free GP care for the under 6’s and the over 70’s. Bring those two things in, and Leo will be hailed for decades as the man who brought in free GP care. If that proves impossible, not only will Leo look bad, but Fine Gael will find the next election very difficult.

Now, it would be a mistake to think that this is the Minister’s only area where he can get a result. If the GPs prove too difficult, if it proves impossible to get agreement, he will try to do things with waiting lists and other issues such as mental health. But free GP care would be the thing that Fine Gael could shout about in an election that would resonate with people. It’s tangible.

As I’ve mentioned previously, the great thing about giving free GP care to those groups is that they are easy targets during an election campaign. It’s easy to say to a complaining mother on the doorstep, “Yes, but at least we got free care for your young ones.”

He mentioned it again at the press conference yesterday. When asked about free GP care and when it would happen he said: “Well, that’s up to the IMO.”

Now, I don’t know how many GP’s are members of the IMO (Irish Medical Organisation), and let’s face it, they’re unlikely to tell me. I do know that there are over a 1,000 GP’s in the NAGP (National Association of General Practitioners), but it would seem that the Minister doesn’t want to mention this awkward fact.

But therein lies the problem. The IMO and NAGP aren’t working together as well as they might. The inter-union rivalry is perhaps necessary for their own futures, but at the moment, it is providing a phalanx of medics that is easily divided and conquered.

That said, he will have to do a deal, and he will need agreement with a good percentage of GP’s. Agreement with just the IMO (or just the NAGP) would be a result. He could say he had achieved free GP care and that just a handful of doctors weren’t participating. He could make it all the doctors’ fault. But if the IMO and NAGP both say ‘No’, Leo will have lost momentum with his colleagues and his leadership ambitions are shot.

So he was hardly going to give away what he would see as ‘concessions’ to the profession when he will need to give away something in upcoming negotiations over the coming weeks. Let’s face it, if he had reversed the FEMPI cuts now, would the two unions have not asked for more when those negotiations start.

Of course they would. It’s only human.

So he couldn’t do that now. It doesn’t mean he won’t. But it does require that the IMO and NAGP stand together and operate a joint negotiating strategy when dealing with him on the free care issue. If they don’t, they will only succeed in shooting themselves in the foot and let down their hard-pressed GP members. That would be a catastrophe for GP’s, but it would also hurt both organisations.

The old adage holds true – there is nothing for nothing in this world. Nobody really ‘gives’ you anything. You have to earn what you get, and to earn the scraping of the FEMPI cuts, GPs have to give Leo a shot at being the ‘free GP care’ hero.

There are many more issues which can’t be neglected. What about those GP’s who borrowed heavily to build state-of-the-art Primary Care Centres and are now over-stretched? Something has to be done to deal with their huge debt and to keep those Centres going. A new contract that offers some kind of security for current and new GP’s is essential.

But all these issues will be on the table in a few weeks, and the most vital thing is that all GP’s act as one, despite the inter-union rivalries. It is still possible that this could be a win-win for both Minister Varadkar and Irish general practitioners, but doctors now need to focus on being united and that union has to incorporate both medical groups.

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