The GP contract leak controversy came against a background of a government wanting to extend family doctor services; bitter rivalry between medical organisations; and legal restrictions on how negotiations on fees should be conducted with professional groups who were not employees.
Key government priorities had been the provision of free GP care to additional cohorts of children and having more types of care carried out in the community to alleviate pressure on hospitals. GPs argued that due to cuts of €120 million imposed during the austerity years they could not take on additional services without greater State investment.
All sides agreed the then 50-year-old GP contract with the State needed to be modernised, but the process was not straightforward.
Family doctors are not State employees but rather are independent contractors. Under competition law, they are not supposed to negotiate collectively on fees.
A High Court case had resulted in a framework agreement between the Irish Medical Organisation (IMO) and the government on a process to be followed.
The then government decided it would negotiate with the IMO as it was the signatory to this framework agreement.
However, at the time there was another organisation representing family doctors, the National Association of General Practitioners (NAGP).
It was not a signatory to the framework and was not affiliated to the Irish Congress of Trade Unions but said it represented 1,200 GPs.
Consultations
The Department of Health held consultations with the NAGP but negotiations took place exclusively with the IMO.
By late spring 2019, these talks were nearing conclusion. On April 3rd, The Irish Times reported that the government was close to finalising a €200 million agreement which would involve the introduction of new services for medical card patients with chronic illnesses.
In return for the reversal of cuts and the provision of new funding, the IMO would co-operate with reforms and drop its objection to the extension of free GP care to more children.
On April 5th, the IMO confirmed a €210 million deal with the government.
The following day, the then taoiseach Leo Varadkar formally announced the agreement and said it would lead to the phased introduction of free GP care for children up to age 12.
In November 2020, Mr Varadkar told the Dáil he had sent a copy of the contract to the then NAGP president, Dr Maitiú Ó Tuathail (who he described as a friend but not a close friend), between April 11th and April 16th, 2019, on a confidential basis, believing that it would be published in full imminently.
However, the final document was not formally agreed with the IMO until May 8th and published a week later.
Mr Varadkar said he wanted the NAGP to support the contract process. But after receiving the contract, the NAGP did not try to “sell” it to its members. In fact, it gave the impression publicly that it was in the dark about its contents.
On April 29th it said: “It is now three weeks since the announcement of the new contract and to date there is no sign of any contract or contractual document. Until we see the contract document, it is impossible to advise members.”
At the time, the NAGP was on the verge of imploding amid concerns about governance and spending at the organisation and within weeks it had fallen apart.
