Sir, - I read with interest the reports by your excellent Medical Correspondent, Dr Muiris Houston, concerning a document from the Health Strategy Group 2001, entitled "Recommendations for Primary Care." The document recommends the most far-reaching changes ever proposed in this country for primary care, and my area of interest, general practice.
As far as I am aware, in spite of the Minister's promise of "wide consultation with interested groups", the group and the Minister failed to discuss the proposals with the GP representative organisations, the Irish College of General Practitioners and the Irish Medical Organisation. The changes proposed are so radical that both organisations would have to be intimately involved if the proposals are to become reality.
The New Zealand model on which they are apparently based might have some possibility of success if our current infrastructure and professional relationships were like those in New Zealand. But at present there is no working relationship between public health nurses and GPs, still less with public health doctors. The relationship with the health boards is at an all-time low. None of the community support service which are supposed to form a team with GPs have ever shown any interest in such involvement.
At present, GPs are independent contractors and are not health board employees. If these proposal are to be implemented, GPs will have to be health board employees and presumably this will extend to all GPs and not just to the 1,784 in the GMS service. But no one has spoken to us about this fundamental change in our position and working relationships.
Services are to be provided by central premises in each area. But what of existing GP premises and where are the centres that could provide such a comprehensive service?
We have already just had the unedifying spectacle of this Minister's introduction of a non-means-tested medical card for the over-70s, a grossly inequitable move that seriously disadvantages the poorer sections of our population and families at the margins of eligibility, so I suppose that we should not be too surprised by this latest proposal.
It is ironic that such changes are being proposed to almost the only area of the health service that actually works, is available without waiting lists, is cost-effective and efficient. The only conclusion that I can reach is that this is a political ploy and that it bears all the hallmarks of an imminent general election. - Yours, etc.,
Dr Garrett Hayes, Lucan Court Medical Centre, Lucan, Co Dublin.