RTE Radio 1 - This Week
GPs - GMS
Dr Ronan Boland was interviewed on RTE Radio 1’s This Week programme. He was speaking about the IMF/EU recommendations in relation to the operation of the GMS scheme.
The following is a transcript of extract from the interview.
Gavin Jennings
So the Health Minister agrees with the IMF/EU plan for GPs but do the doctors? In our Cork studio is the President of the Irish Medical Organisation, Dr. Ronan Boland. Dr. Boland, thank you for coming into us today. The EU/IMF want us to train more doctors and allow more of them access to medical card patients. It’s a good idea isn’t it?
Dr. Ronan Boland
I think it is a good idea to train more doctors, I think it’s well recognised and I think everybody would agree that we have a shortfall in terms of the number of GPs that we’re training and we also have a problem in that the age profile of Irish GPs indicates very clearly that we’re going to have a significant number of retirements over the next ten years, many of those being singlehanded doctors in rural areas who already we are having great difficulty in replacing in a like for like basis given the shortfall that we’ve had. So yes, we do need to train more doctors and that’s something that we would have subscribed to for some time.
Gavin Jennings
And increasing or opening up the GMS scheme to every qualified GP?
Dr. Ronan Boland
Well I think that’s a complex and double edged sword and I was listening to your previous report, one thing I would have to point over very clearly, one of the contributors to the package, Dr. Hanley, contended that the IMO has a veto in relation to the appointment of doctors…
Gavin Jennings
You do.
Dr. Ronan Boland
That is not correct, the only obligation on the HSE is to consult with the IMO in relation to the filling of posts and I have personally been involved in that consultation process many times down the years and generally the dynamic has been, in my experience, that back to the days of the health boards, that the health boards often wish to have a particular post suppressed because they were small and semi-viable or non-viable and the IMO has consistently insisted, and I personally have insisted, that those posts be advertised and if there was a suitably qualified doctor who felt that that practise was viable that that doctor should be given the opportunity to apply for that post. In relation to new…
Gavin Jennings
Well hang on, bear with me for one second, the IMO is centrally involved in all stages of the process governing the number, the location and the allocation of GMS contracts. IMOs are on the committee of the panel who sit for GMS positions and you’re centrally involved in the contract negotiations, in fact it has to be done in agreement with the IMO before the GMS can be signed on so you do have a veto.
Dr. Ronan Boland:
No we don’t have a veto but yes you are correct, that we are involved in the process and that’s partly because it forms part of the GMS contract, it’s partly because we have the experience and the expertise and could I tell you that as part of my role in the IMO I’ve sat on those interview courses for many years, I’ll be sitting on one before the end of those coming month in the south of the country where I work as a GP myself. We have a rural GP who’s retired and we have one applicant for the post, we have two posts in the west of Ireland recently where there have been no applicants. So one has to be careful when one prescribes some form of complete deregulation of the GMS as a silver bullet because…
Gavin Jennings
Why, what would be the problem?
Dr. Ronan Boland
The problem would be that we have a difficulty and we spent a year working with the Department and the HSE in relation to seeing how we could make it easier to streamline the process for younger doctors who, remember, are members of our own organisation, medical students, non-consultant doctors, GPs in training, GPs, they’re all part of the organisation of doctors that I represent as President and it’s in our interest to make sure that those doctors are represented, and one of the things that’s clear, which we already knew in fact, which is, is that there has been real difficulty in attracting younger doctors to rural areas, to singlehanded practises.
Gavin Jennings
But why would opening up competition change that? You would have more doctors and more competition, why would that make any difference to that?
Dr. Ronan Boland
If I can explain? Because we have, we’re all agreed that there is a shortage of doctors and it behoves, and one has to remember that in this country the State is the chief purchaser and controller of GPs services, only 40% of the population have medical cards but that includes the vast majority of older people, people with cancer, people with chronic diseases and the State has a responsibility and we also have a responsibility as doctors to ensure that the whole population has access to suitably trained GPs and in a situation where you have, where the State loses, this isn’t just about the IMO remember, this is about the State having in input into the supply and distribution of doctors, and in a situation where any suitably trained doctor can open a practise wherever that doctor wishes the experience, and we’ve been there before, we had a similar situation in Ireland up to 1989, doctors gravitate towards urban areas, towards university towns and you get a proliferation of small, semi-viable practises and Professor Tom O’Dowd, earlier in the report, would absolutely agree with, general practise is not a commodity like groceries or petrol, doctors working in the community are a significant, either a driver or an inhibitor of cost in terms of referral rates to hospital, investigation rates and so on, so what you don’t want is doctors sucked out of rural areas and areas of urban disadvantage when we already have real difficulties in those areas.
Gavin Jennings
I’m completely confused here, why would a doctor be sucked out of a disadvantaged area when the vast majority of patients in a disadvantaged area have medical cards, it’s far more lucrative arguably to set up in a disadvantaged area than it would be to set up, as you said, in the soft suburbs or the university areas. I still don’t see your objection as to, if there are more doctors qualified, as you suggest is a good idea, allowing them to compete for GMS schemes, for medical card patients, wherever they choose. What’s the problem?
Dr. Ronan Boland
Well in terms of competition I’m a GP in an urban area myself, there are six GP practises within a quarter of a mile of my own surgery and that would be typical in Ireland. In terms of patient choice in urban areas I would contend that there is plenty of choice, the difficulty…
Gavin Jennings
Well not according to what we heard from the Competition Authority, they say that some of the biggest black spots identified by the ESRI are in commuter areas which are big population centres.
Dr. Ronan Boland
Which I would completely agree with and part of the difficulty has been there, that you have had huge demographic shifts in terms of population movements over the last ten to fifteen years, with huge growth in towns around the commuter belt, around Dublin, and there needs to be greater flexibility around creating new lists, to allow doctors to set up in those areas but one must remember that whether you have one patient or a thousand patients or two thousand patients, and particularly in the era of HIQA and other regulatory bodies and planning regulations, you’re obliged to provide proper premises, to have staff and all those things are extremely expensive so to, for one to suggest that creating zero patient lists and we’ve been party to the creation of some of those and that’s some form of panacea, it is extremely difficult for our practise to have the range of services and resources that are required so, as I’ve already said, it’s not a silver bullet to solve what are really quite complex problems.
Gavin Jennings
Okay, so briefly in the time that we have left you’ve said that you’re opposed to opening up the medical card scheme to open competition, therefore are the Government, the EU, the IMF, the OECD, the Competition Authority, are they all wrong? Is it a case that doctor knows best here?
Dr. Ronan Boland
No, I haven’t said that we’re opposed to it, what I have said is that they form part of a contract which is twenty-two years old, we need, we have a problem in this country that we’re not training enough GPs, we also have a problem that there is a worldwide shortage of GPs and that every week in our own trade newspapers other English speaking countries are offering salaries that cannot be matched in this jurisdiction to attract young doctors and already there’s evidence of doctors leaving the jurisdiction. So what we need to have is we need to sit down with the new Minister to put in place a new contract, as the Minister has indicated that he wishes to do, which we would welcome. We’ve already spent a year working with the HSE and the Department to seek to address a lot of these issues and we reached together conclusions around things like the marking schedule but I think that this issue needs to be addressed in the context of an overall review of the GMS scheme.
Gavin Jennings
Okay. Dr. Ronan Boland, President of the Irish Medical Organisation, thank you.