The Government intends to give power in legislation to the Minister for Health to set
fees and allowances paid by the State to GPs .
The move will be included in legislation to provide for the introduction of free family doctor care to young children.
In the past, fee rates for GPs operating the medical card and other schemes were determined as part of collective bargaining between the Department of Health and doctors' representatives. However, the Government has argued that, under competition law, it can no longer negotiate fees with trade unions such as the Irish Medical Organisation, as GPs are independent contractors and not employees of the Health Service Executive. Doctors have disputed this.
In a letter to the Irish Medical Organisation, Minister of State at the Department of Health Alex White said there could be negotiations with doctors on the scope and content of a contract. He also suggested there could be a complementary process regarding the fee structure for any new deal on the provision of free GP care for children under six.
Fee consultation
He said the IMO would be consulted before fees were set and it could make submissions on what it considered to be appropriate levels. However, he maintained "the ultimate setting of fees must remain a matter for the Minister for Health".
The Government is seeking to introduce free GP care for children under six from later this year, as a step towards a universal free GP service.
The draft contract has been roundly rejected by groups representing family doctors.
In his letter to the IMO, sent on Wednesday, Mr White said he welcomed confirmation the doctors’ trade union was supportive of Government policy to introduce free GP care. However, he noted this backing by the IMO was qualified by conditions such as the provision of adequate resources and “full and meaningful negotiations” .
Mr White said the department did not dispute the IMO was a registered trade union and had a negotiation licence. He said that the licence allowed the IMO carry on negotiations for the fixing of wages or other conditions of employment.
Mr White said GPs were not employees of the HSE "and therefore the negotiation license is of limited relevance in this context . . . In any event, established competition law principles must apply to any engagement with GPs."
Mr White said the Department of Health and the HSE accepted there was a clear relationship between the scope and content of the contract and the fees to be paid. He said that was why “we have arranged a complementary process regarding fees”.
Open discussion
He said he was confident a process of open discussion on the scope and content had the potential to significantly enhance it for patients, GPs, the department and the HSE.
Mr White said the fee structure would be addressed in a further process before which a proposal would be tabled. “Once the fee structure is determined, the setting of rates will be a matter for the Minister for Health, subject to the provisions of legislation currently being drafted.”
