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These consequences are both cultural and practical. The most significant personal impact is for women who will no longer have to travel to the UK to terminate a pregnancy. At a professional level, a group who will be considerably impacted by the vote are, of course, doctors. Given remarks that the new abortion service would be GP-led, it was perhaps fitting that the referendum was held on Friday 25 May, and the results were announced on the Saturday, the same days as the ICGP AGM 2018.
A large part of the referendum debate centred on ethical grounds. Discussion has now moved on to practicalities. Although conscientious objection is an ethical stance, decisions will have to be made about how this will work in practice. Will the service be opt-in? Will GPs who conscientiously object be obliged to refer?
At the ICGP AGM, GPs expressed concern that resources are already severely stretched, with some saying the service could not be delivered within day-to-day practice. For years, GP groups have said there is a capacity problem within general practice. The College has predicted GP shortages throughout the country in the coming years. Access to diagnostic tests, such as ultrasound, remains sub-standard. Free care to children aged under six years has put more pressure on services than the HSE predicted.
Any plan for GPs to deliver an abortion service cannot take place without acknowledging, or addressing, these realities. At this stage, it is not even certain that the new service will be led by GPs. What the Minister for Health Simon Harris has now said is that it will be “doctor-led”.
These are still very early days. It is vital that the discussions ultimately succeed in delivering as high a standard and as safe a service as possible, in whatever form that service is configured.
During the referendum campaign, Minister Harris received fulsome praise from the ‘yes’ side for the part he played in the debate. There is little doubt the Minister can be very eloquent and persuasive when arguing his case. However, the week after the referendum, he came in for criticism for not putting his words into action with regard to Sláintecare. It is now a year since the health policy was published, yet little has happened. Minister Harris continues to publicly support Sláintecare, but genuine support would involve ensuring a detailed implementation plan is developed and resourced. Deputy Róisín Shortall, who chaired the Future of Healthcare Committee, said there was a danger that the unique opportunity to achieve the reforms envisaged in Sláintecare would be squandered. It is a good reminder that Ministers should be judged on what they do, rather than just on what they say.