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Community medicine: The battle for greater recognition

By Dr Ann Hogan - 17th May 2022

Irish Medical Organisation
Irish Medical Organisation, Annual General Meeting, Aviva Stadium, 28 May 2022

Irish Medical Organisation, Annual General Meeting, Aviva Stadium, 28 May 2022.

Chair of community health with the IMO Dr Ann Hogan reflects on what the last year has meant for community medicine and expresses disappointment about the continued inequitable treatment of area medical officers.

As we prepare for the IMO AGM there is a lot to reflect on for community health and its role in 2021. 

We have always argued for a greater recognition for the role of our community medicine doctors and we hope that the work during the Covid-19 pandemic will lead to this recognition. 

The country entered 2021 in a very difficult position, with a further wave of Covid-19 and increasing levels of illness and hospitalisation. The roll-out of the Covid vaccine was a very welcome ray of light. Community medicine doctors were delighted to be part of the vaccination teams, which delivered the vaccine to patients and staff in nursing homes. Our experience from our role in the school immunisation programmes was useful. 

During the pandemic we were also able to continue to deliver the school immunisation programmes, including the human papillomavirus (HPV) vaccine, to primary and secondary school students in large central clinics when the schools were closed. Prior to the pandemic, significant work had been done to fight back against vaccine misinformation, leading to increased uptake of HPV vaccine among secondary school students. The extension of the HPV vaccination programme to boys had started well in September 2019. Our school immunisation programmes were severely disrupted during the pandemic. However, our teams stepped up in 2020 and 2021 to deliver the programmes, despite challenges such as school closures; lack of space in schools, which had to use halls as classrooms; staff shortages due to redeployment and due to Covid 19 illness; and different ways of working due to Covid 19 control measures, including social distancing. 

Our senior medical officers and area medical officers continue to deliver child health clinics and the other key duties of the role. 

Despite this commitment, we still need to see action by the HSE to address a number of the key challenges faced by our specialty. 

I am very disappointed to again have to write about the continued unfair treatment of our area medical officers. Since 2004, the IMO has been pursuing the rectification of this long-running unfairness. In 2021, we had been engaging with the HSE through a Workplace Relations Commission conciliation. The HSE had firmly committed to dealing with this through a separate process provided for under Building Momentum, the current public services pay agreement. 

This process (the bargaining unit process) provided specific funding to address long running claims and disputes. The IMO had a number of engagements in late 2021 around this process. Unfortunately, despite the agreement providing for an implementation date of 1 February 2022, we have had no meeting in a number of months and indeed no specific feedback on our proposal on this issue. 

We can see no reason for a delay with this, and it adds insult to injury that the HSE, Department of Health, and Department of Public Expenditure, far from acting promptly to resolve this issue, are in fact not even abiding by the timelines or keeping to the terms of the wider national agreement. 

We note that, if this process does not address this issue appropriately, the IMO reserves the right to go the Labour Court on the matter. 

In addition to the AMO issue, recruitment continues to be a challenge for the community medical service. We had engaged with the HSE on this prior to the pandemic and we are looking to resume this engagement in the coming months. There is a need for action to ensure adequate staffing levels in the community medical service as the workload is increasing in quantity and complexity. It is imperative that jobs can attract young doctors to replace those who will shortly retire. 

So, we hope that the employer-side will show the same commitment and effort as our community medicine doctors have consistently shown. This commitment and effort has been taken for granted for too many years now and if urgent action is not taken, there will not be a service there able to provide the vital work in vaccinations and child health or to respond to new challenges, as we did during Covid-19. 

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