General practitioners are committed to team-work involving other healthcare professionals in which a patient's right to choose a doctor is preserved, the Annual Scientific Meeting of the Irish College of General Practitioners (ICGP) was told at the weekend.
However, Dr Michael Boland, president of the World Organisation of General Practitioners and director of the postgraduate centre at the ICGP, suggested that the new primary care teams - expected to be announced in this week's National Health Strategy - be confined to general practitioners, practice nurses, public health nurses and pharmacists.
He argued that all other primary care professionals, including physiotherapists, occupational therapists and social workers, were specialists who should be accessed only on referral from the primary care team.
Dr Boland asked whether it would be possible to maintain the standard of care provided at present by GPs if broad-based teams were introduced.
Addressing the issue of who might lead primary care teams, he suggested that this be based on a respect for the professionalism of an individual team member.
"If a practice nurse does 90 per cent of the work in a particular area, she is effectively the team leader," Dr Boland said.
He added that leadership must rotate around all primary healthcare professionals.
Referring to recent speculation on the primary care proposals in the health strategy, he said: "There is a subtle difference between 'personal care', as advocated by GPs, and 'people-centred care', as put forward by administrators; there will have to be compromise with health board managers on this issue as the health strategy is implemented."
Prof Igor Svab, head of the department of general practice at the University of Lubjlana in Slovenia, told the meeting there was no such thing as total professional independence.
Putting forward a European perspective on professional independence in general practice, he said doctors' autonomy was directly related to the balance struck between the medical profession and those who paid for health services.
"General practice is now clearly seen as probably the only profession that can help to maintain the healthcare system in a manageable state.
"Without the contribution and co-operation from general practice, no health ministry can hope to manage," he said.
Every partnership would have problems, but the way to minimise these was to have solutions based on trust, according to Prof Svab.