In a significant change of policy, the Health Service Executive (HSE) will today invite tenders from private companies to provide out-of-hours GP services in Dublin.
The move has angered family doctors who have expressed concern about its effect on their medical card contracts, as well as on existing GP out-of-hours co-operatives elsewhere in the State.
According to sources close to the Department of Health, the decision came about because of "political frustration" at the failure of doctors in north Co Dublin to reach agreement with the local HSE executive on a unified system to meet the demand for emergency medical care outside of regular surgery hours. It is estimated that 2,000 patients per week require out-of-hours services in the area.
The enhancement of out-of-hours GP services in Dublin was flagged by Minister for Health Mary Harney as one of the key initiatives in her 10-point plan, announced last year, to deal with the crisis in hospital A&E departments. The Irish Times understands that finding a solution to out-of-hours services in north Dublin is a priority for new HSE chief executive Dr Brendan Drumm.
Dr Ray Walley, chairman of the North Dublin GP Co-Operative and a north inner city GP, said last night he and his colleagues were "disgusted" at the HSE decision. Referring to negotiations that had taken place between his group and the HSE since February last, he said: "The proposals of service by north Dublin GPs have been wholly disregarded.
"There is an ongoing GP manpower crisis which is at its worst in north Dublin. It is likely that out-of-hours GP cover will be provided by foreign-trained doctors . . . These are doctors who cannot apply for GMS medical lists in the Republic because of insufficient GP training, yet will be deemed fit to see my patients at a time of most need."
A HSE source rejected a claim by doctors that the move represented privatisation by stealth. "This is a local initiative to deal with a local situation," he said. Asked whether it meant a breach of the medical card contract with doctors, the source said: "There is no breach of the GMS contract. This is an enhancement rather than a replacement of medical services." He confirmed that groups of GPs had been invited to tender for the out-of-hours contract as well as private firms.
In a letter being sent to family doctors today, the HSE describes the initiative as "an expanded service which is necessary to address the heavy workload facing GPs in the area and the growing population".
The chairman of the GP committee of the Irish Medical Organisation, Dr Martin Daly, said "there is some dismay at this proposal that out-of-hours GP work be tendered to the private sector". He described the move as "surprising" in light of the lack of Government investment in the primary care area.