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The HSE deducted the costs of these tests from the GMS fees owed to around 50 GPs, while many more GPs who charge for such tests now face uncertainty.
GPs have long argued that certain blood tests are not covered under the existing contract, while the HSE argues the opposite.
GP representative bodies support their members’ rights to charge for blood tests that they do not feel are covered under the GMS, and point out that phlebotomy is available free of charge to public patients in HSE hospitals.
GPs have seen their GMS earnings decimated since the recession and now have to deal with the increased workload brought by the summer introduction of free GP care for under-sixes and all over 70s. They are also constantly being pushed to take on more chronic disease management and urgent care out of hours, despite the lack of resources.
GPs have been promised a new GMS contract ‘is just around the corner’, which will deal with all these issues, but that does not help those who are in serious financial trouble and those who have left our shores to seek better working conditions and remuneration abroad. GPs have also long been promised more access to diagnostics in the community and to be fair, it was mentioned in the 2016 Budget, but again, promises are easy — it’s the exact details and actual commencement of such things that continues to elude.
In addition, the recent publishing in the media of the 2014 GMS earnings figures for GPs, following the release through a Dáil PQ, has caused the usual consternation in general practice. These figures are published annually and usually far earlier in the year than November. GPs understandably do not like having the details of their public income with their addresses made public. Some of the media stories over the years have made it appear as if these figures are individual payments as opposed to gross per practice earnings, before tax, overheads and practice staff costs — though coverage has become more nuanced in recent years. Is there a better way to balance transparency on the spending of public money versus the sensitivities of GMS GPs?
In the meantime, these petty payment stories do little to entice GP trainees to stay in Ireland or to encourage those abroad to return home.
There have been varying reports on when the GMS talks will conclude, with suggestions of next March, to closer to the end of 2016. The NAGP, which says it now represents over 1,500 GPs, is not yet involved in the talks, though as reported by this newspaper last month, Ministerial attitudes in the Department of Health are softening in this respect.
HSE medical contract negotiations have a history of being painfully protracted and often bitter, with implementation of the terms — by both sides — a continuing bone of contention with the 2008 Consultant Contract, for example.
In the meantime, demand for GP services continues to increase in Ireland, while older GPs retire and younger ones continue to leave the country or eschew unviable rural practices. While universal health insurance has finally been officially dropped, universal GP access remains firmly on the Government’s healthcare policy agenda.