The debate on primary healthcare now generated by The Irish Times is necessary, healthy and long overdue. Primary healthcare is the bedrock of any health system. According to the World Health Organisation, it is "a practical approach to making essential healthcare accessible to individuals and families in an acceptable and affordable way and with their full participation".
What is remarkable, though, about this debate is that it does not arise from full public participation. It is based solely on a leaked document from the Department of Health.
In Ireland today there is no framework for exploring the issues between policy-makers and primary-care professionals and for developing new strategies to provide a primary healthcare service grounded in the principles of excellence and value for money. No formal partnership arrangements, no statutory role for patients, no national forum on health, as proposed by the Labour Party, no standing committees that refer back to the people. The much-trumpeted drawing-up of a health strategy is being done in secret. All we have are leaks.
As the representatives of the Irish College of General Practitioners have pointed out, patients, whether private or on medical cards, have the freedom to change their GPs and are entitled to expect standards of care and good access. At primary level, patients are empowered in a way that public patients, trying to access hospital care, are not. Primary care is personal care and, by law, must be delivered on an equal basis. These principles do not apply in the apartheid of our hospital system.
Yes, primary care has served us well. But it has a capacity to deliver significantly more. Countries with strong primary-care systems tend to have healthier populations, lower healthcare costs and more primary-care physician availability.
Primary-care doctors who establish long-term relationships with poor patients and co-ordinate their care can protect them from some of poverty's worst health impacts. Regular visits, too, to the same primary-care centre tend to mean fewer visits to a casualty department.
General practice could provide a wider range of services. Even in the long-term management of chronic illnesses, such as asthma or diabetes, GPs could play a greatly enhanced role.
The strengths of general practice - personal service, flexibility, choice - must not be lost because of some Departmental desire to re-create the old dispensary system in a new guise, as indicated in the leaked report.
The record of this Government is not good. The recent extension of medical cards to the over-70s has actually introduced a new and iniquitous element into primary care. GPs are to be paid, under the recent deal hammered out with the doctors, four or five times more for caring for their richest over-70s patients compared to their poorest over-70s patients. It is a deal that discredits both the Minister for Health and the doctors.
Already GPs practising in areas of deprivation are at a disadvantage because they tend not to have many private patients. Research has shown that a patient is three times more likely to find a GP in a well-off area than in a socially deprived one. This deal will make that difference more acute.
It also raises the need to eliminate the differential between patients at primary-care level completely. If designed properly, a free GP care service for all is perfectly feasible, particularly as part of a universal health insurance scheme. Other EU countries have made the leap years ago, so why shouldn't we?
Patient registration - a vital part of an expanded primary health service - would flow naturally from such a system. Encouragement towards group practices, greater integration between primary and hospital services and enhancement of primary care while retaining the best features of current general practice would also be facilitated.
The preliminary skirmishes, as evidenced in The Irish Times, between Department and doctors are only part of the picture. There is a lack of any real sense of ownership by Irish people of our health service and it needs to be addressed. If primary care is to be central to our health service and to meet the needs of all our citizens as it should, then patients - and that means all of us - as well as policy-makers and service providers need to be part of the project.
Liz McManus is the Labour Party's spokeswoman on health.