The extension of the State-funded GP services agreed on Thursday with the Irish Medical Organisation potentially represents the greatest transformation of primary care since the introduction of the medical card scheme nearly 50 years ago.
The deal allows for the long-awaited introduction of free GP care for children aged under six and the provision of such services to everyone over 70. In addition it would put in place a new diabetes cycle of care for all patients with a medical card or GP visit card.
The Government believes that the measures could benefit about 300,000 children and older people who will no longer have to pay to see their family doctor.
However individual doctors will have to decide on whether to participate in the new arrangements and it remains to be seen how extensive and uniform the the take-up will be ultimately.
GPs are independent contractors rather than employees of the State and putting in place a deal for the introduction of free GP care for young children has been much more complicated that if it simply involved a productivity agreement with direct employees.
As competition law applies in this area, a different type of negotiation arrangement had to be followed by the Irish Medical Organisation (IMO) in the talks that led to the agreement on Thursday.
The IMO was permitted to negotiate on the scope of a new contract, the resources on offer and the fees payable. It could not recommend acceptance or otherwise.
The IMO is allowed to offer an opinion and has said it believes the new measures and associated fees represent a good deal for family doctors. It contends that the agreement involves the first stage in a process of further initiatives that could benefit general practice.
The IMO has argued that the new deal will lead to an investment of a further €75 million in general practice.
It also points out that with the introduction of the new fees for diabetic care, the concept of payment for chronic illness control has been brought into general practice.
The IMO will also have the opportunity to negotiate on further State investment in planned talks later this year on reversing some of the €140 million in cuts to general practice resources put in place under financial emergency legislation by the government since 2009.
Planned negotiations on a revised overall GP contract are also likely to trigger claims for additional payments.
To make matters more complicated another organisation representing family doctors, the National Association of GPs, is opposed to the new deal for children under six.
It contends that the move is unfair and inequitable as older children with serious illnesses will not receive free GP care.
Ultimately individual doctors will have to make up their own mind on whether the accept the new package.
If there is a low take up or if large numbers of doctors in particular parts of the country boycott the new scheme, the Government could face difficulties.
On the other hand, legislation introduced last year allows the Government to move children under six from the lists of GPs who do not sign up to the scheme and transfer them to other doctors. Such a move could mean patients having to travel some distance to avail of the new free GP care scheme.
GPs for their part will be mindful that if they lose their existing under six patients, parents who currently pay private fees may also opt to move elsewhere.
A full assessment of the success or otherwise of the planned new scheme may not be known for a few months until the take-up levels are confirmed.
