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IMO AGM 2011: Protecting our health service

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IMO Chief Executive Mr George McNeice tells Danielle Barron about the difficulties facing GPs, consultants, and NCHDs.

Almost 13 battle-filled months later, the IMO AGM is once again ready to be checked off the calendars. No cohort of doctors has remained unaffected by sweeping budgetary cuts and the new Government has promised many more changes to come. With a new Minister in attendance, the IMO is champing at the bit to once again make a difference using the voices of their members. Chief Executive of the IMO since 1993, Mr George McNeice tells IMN that while the change in Government is something new for this year’s AGM, many of the old problems still remain and in some cases are even more serious than before.

 

Mr McNeice explains that while the IMO is awaiting its first official meeting with the Minister, his attendance at the AGM on Friday April 30 is very welcome. “We have always been happy to work with ministers and Government and hopefully that will be a fruitful engagement.” Any talks will place within the context of the Croke Park Agreement, says Mr McNeice. “We are happy to work with that. They have suggested that they want to negotiate a new GMS contract which is fine – we agreed that as far back as 2005. We have to resolve and clarify the competition issue, which everyone has agreed is as much in their interest as it is in ours so presumably that will finally be gotten out of the way.”

The new GP contract, in particular, is central to the whole health transformation programme contained within the Croke Park Agreement. The section on the GP transformation programme has to be agreed, and as soon as that is agreed and done and dusted, the better for everybody, he says. The new GMS contract must be flexible in order to take into account the introduction of GP care that is free at the point of access. “The old contract had conditions added onto it every few years, while the core contract remained. You can negotiate a contract where the intention may be to provide care at the point of access but you may decide to do that over a number of years and have a staggered approach to it.” Rural GPs have been disproportionately affected by cuts in GP fees, particularly those in relation to distance code payments.

“There was never supposed to be one group affected more than others, that is an anomaly in the system, and we hope that will be resolved by the imminent review of the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009,” he says, adding that cuts to out-of-hours payments by the Primary Care Reimbursement Scheme (PCRS) are also particularly affecting rural doctors. Consultant contract issues are also high on the agenda with the promise of a new contract somewhat remiss when the existing contract was never implemented, Mr McNeice asserts. Regardless of the salary issues involved, this is particularly relevant to the Acute Medicine Programme, he says. “There is provision in the current contract where consultants can work sessions on Saturdays and Sundays, so that may well resolve that.”

In the context of a universal health insurance system, consultants doing both public and private work may need a new contract, which would deal with this situation. “It is unclear how this is going to develop. Certainly, in relation to the Croke Park elements of it, the consultants’ salaries are guaranteed, like everyone else’s under the Agreement. The issue of the Clinical Care programmes and the Acute Medicine Programme can be dealt with under the existing contract, where consultants can be scheduled to work over weekends. We are already in talks with the IHCA and the HSE in relation to the implementation of those elements of Croke Park.”

According to Mr McNeice, consultant salaries are often wrongly quoted, and usually way off the mark. “Even politicians are quoting that consultants earn €250,000 each year on their public contracts, when they actually earn 45 per cent less than that. If the Government, and the HSE in particular, are serious about collaborative engagement with the medical profession, and that includes nurses and everyone, they have to stop using the media with these types of income figures trying to create ‘shock horror’. They also compare us with other European countries instead of comparing like with like, for example, consultants in the UK get merit awards, which are never taken into account when comparing the two salaries.” The current NCHD crisis can be traced back to contractual issues, believes Mr McNeice.

“NCHDs are supposed to be working 48 hour weeks, but they are not because this was never implemented by the HSE and now they cannot get NCHDs to work for them because the contract is poor, the implementation is poor and the way they are treated is very poor. We keep being told that NCHDs have earned up to €125,000 in overtime when they may have worked upwards of 100 hours in one week, which is both dangerous for patients and the doctors themselves.” The IMO had warned the HSE of the current recruitment problems, says Mr McNeice. “They have been proven to be wrong at every stage of the process and we all really need to sit down and figure out a solution to this issue, whether it is making the posts themselves more attractive, perhaps the non-training posts should be aboloished or made into full consultant posts. The HSE do things their own way and never take anyone else on board and that has to change,” he states, adding that there may be upwards of 500 vacancies by the time the July rotation date comes around. Mr McNeice states that the Organisation finds it extremely difficult to engage with the HSE on every issue.

“Their policy is not to respond to a problem at all. If you are an employee, whether an NCHD or consultant or public health doctor, you have to gothrough all the procedures as far as the Labour Court, and even when we do get a recommendation, such as in the case of Mayo General, they now say they can’t pay it. The HSE policy is to make it absolutely impossible to get a problem dealt with.”

 

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