Free Care deal is a smokescreen for IMO

When the doctor opens up the wound and finds cancer inside, everybody understands the choice – it is either to cut out the tumour, or seal up the wound and allow it to fester. In the latter case, it is only a matter of time until the patient succumbs.

Surprisingly, however, the Irish Medical Organisation continues to leave the cancer inside, and hope that its outward appearance of health will fool everyone into believing that nothing is wrong.

Last week the IMO ‘agreed’ a deal with the HSE and the Department of Health on free care for the under 6’s, but it would be a mistake to think that the deal will be accepted by a majority of GP’s – let alone the 80% required to make it work.

That is because the rival National Association of General Practitioners (NAGP) still opposes the deal and many within the IMO may refuse to sign up for it also. So why the media fuss just two days before the IMO conference announcing a ‘New Deal’ as if it were the medical breakthrough of the century?

The reasons have a lot more to do with the IMO’s problems than the problems within the health service in general and general practice in particular.
Since the departure of the IMO’s chief executive, George McNeice, and the subsequent huge pension of €9.7 million awarded to him, IMO members have been asking questions about how the union was run, and continues to be run.

The very public case of another executive who sued the union for holiday pay and accused union officials of bullying was settled out of court, but raised more questions about the union’s modus operandi. These questions won’t go away and are partly responsible for the rise of the NAGP.

The ‘only official union representing GP’s’, as the IMO President, Trevor Duffy, put it this week, has no ‘official union’ status. Neither does the NAGP. Because they are both prevented from any form of union activity that could be considered collective bargaining or, ultimately, striking.

It is an anachronism that a group of self-employed GP’s be represented in the first place by a union, but the IMO seeks to continue this fiction because many of its hospital doctors are salaried and paid in a different way from the GP’s. The IMO cannot reject or accept this deal on behalf of its members – it has to let them decide on its merits themselves. Anything else would be anti-competitive.

Here we cut to the heart of this deal. It won’t become operative until the last quarter of the year, and since it will take a few months to see if GP’s sign up, and there will be an election before there are any measurable results, the whole issue has been deferred until the next government takes power.

That will work nicely for Minister Varadkar who will be able to claim that he has put ‘free care’ in place (not his fault if doctors don’t sign up) and it works especially well for the IMO who can claim something of a ‘result’ just in time for their annual conference.

The insistence on proceeding with care for the under 6’s is a clear warning of the political nature of this deal. Almost every GP in the country realises that while this idea is peddled as a start to Universal Health Care for all, it is in reality an extension of Child Benefit to the middle classes or the ‘squeezed middle’.

GP’s know from their daily experience that any money available should go to those who need it most. The free care for the under 6’s is merely a smokescreen, a chimera trading as the start of something good, but in reality a way of funneling a benefit to the middle class at the expense of the poor and the needy.

There are some good aspects to the proposal. The inclusion of chronic care in general practice is a welcome development, but given the nature of how this deal was agreed, that too might die on the vine since the overall package is unlikely to be taken up.

The timing is also very suspect. The negotiation has been going on for some time, but miraculously it got agreed just in time for the IMO conference. The government needs a win, and the IMO needs a win, and doesn’t it look awfully like they got together to make it happen.

Meanwhile, fortunately for the IMO, all those questions about how the IMO is run and how its ample resources are spent were off the table…for the duration of the conference. One pertinent question which might have been asked, for example, was how much money the IMO have spent on external communications since they were out-sourced?

But there are also questions about what happened under the stewardship of George McNeice – questions the union has repeatedly tried to bury. While that continues, IMO GP members are increasingly likely to defect to the NAGP, or simply reject the union’s suggestion that they accept this deal.

This is the medical equivalent of kicking the can down the road, and hoping that ‘politics as usual’ will be enough to placate the public that something is being done in the health service. And the IMO will hope that doctors will still send their €100 a month to support a union that has no collective bargaining role, and no legal right to take any kind of co-ordinated work-to-rule or strike action to force its demands on a reluctant government.

Business as usual then in the health service.

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