As issues arise of concern to Irelands' front line medical practitioners, the AGP represents members' views to Government.
The precipitating cause for the foundation of the A.G.P. was the imposition of Withholding Tax and the I.M.O.'s acceptance of it without industrial action or any effective action. It was galling to discover later that the cabinet expected resistance to the Tax which was set at a crippling 35% and would have settled for 17.5%! The late Dr. John Hennigan was a negotiator for the I.M.O. at that time.
In 1989 Capitation was introduced by the Department of Health with threatening letters to G.Ps. G.Ps. were divided by Capitation as never before as it suited some categories but heavily punished others. An estimated 400- 500 G.Ps. were initially very much against capitation as their income was to drop by 10% to 25%. However most of these joined capitation out of fear of losing their G.M.S. list altogether and accepted the new deal with a letter declaring they were signing under duress.
The I.M.O. had campaigned with fanatical intensity for Capitation and when the A.G.P. took a High Court Case on behalf of Doctors who opted to remain on fee per item the I.M.O. representatives sat in the Courthouse with the Department Officials. The A.G.P. won this case famously but only 60 or 70 G.Ps. benefited. Today there are about 40 G.Ps. on fee per item.
It is not remiss to bring attention to the fact that in 1986 a modified fee per item was proposed by the I.M.O. (on behalf of the Department with whom there had been negotiations). This proposal seemed to come out of the blue there being no prior discussion at branch or A.G.M. level.
A tumultuous meeting of G.Ps. in Portlaoise rejected modified fee per item (a lesser fee was to apply after a certain number of visits by a patient). The rejection from the floor of the house was determined and vociferous but undeterred the top table persisted until eventually defeated at the end of a long day.
Capitation initially caused hundreds of doctors to lose 10% to 25% of their income. The I.M.O's. embarrassing "first" of being the only trade union to my knowledge of having negotiated a downwards movement in its members remuneration was shortly to lead to crisis in general practice. So many practices had become unviable that mass resignation was a matter of weeks away. This was averted by the "O'Connell Deal", a last minute victory for the Government just before the election of December 1992. The I.M.O. hails this as a victory. In truth the G.Ps., with their backs to the wall had nothing to lose and were in a position of great strength with all the letters of resignation in the I.M.O's. hands. What was gained in the O'Connell deal was the amount lost in the Capitation Deal (except for those categories of G.P. whom Capitation suited from the outset and were now further rewarded). The opportunity was lost to gain right of sale of our lists and a deal on one in one rotas.
The A.G.P. was founded by Dr. Mary Grehan and others in September, 1987. At a meeting in the Greville Arms in Mullingar, an annual subscription of £10.00 was settled and Dr. Seaghan Ua Conchubhair was elected as Hon. Secretary. Seaghan is a past President of the I.M.A. and the founding President of the Medical Union.
If our first victory in the High Court was famous in establishing the right of fee-per-item G.Ps. to continue in the G.M.S. our next two cases were momentous. I describe the withholding tax saga in a separate tract and this was a famous victory.
The A.G.P. case in 1995 before Justice O'Hanlon sought the right to be a negotiating body. The case was lost but in a detailed judgement it was clear that all we lacked was a sufficient number of members. Our Case was strong and costs were not awarded against us.
In September 1997 a scandalous public rift in G.P. ranks needed addressing. Excluding doctors (from the G.M.S.) and established G.M.S. doctors were in rancorous terms displaying mutual dislike and distrust. In this horrid climate the A.G.P. went out on a limb and indeed with the disapproval of established doctors sought reconciliation with the N.A.I.G.P. The N.A.I.G.P. leadership with great courage also linked arms with their older colleagues despite the current strong feelings of its membership. This was a worthy movement towards unity of G.Ps. and the thorny problem of "sale of practice" and "exclusion"
The Executive Committee of the A.G.P. meets approximately every six weeks, usually in the Aisling Hotel in Dublin. The A.G.M. is held in the Autumn and this year will be in Kilkenny in October (inset Hotel and dates). The N.A.I.G.P. A.G.M. will be heldat the same time and venue and a joint session is planned. There will be a joint Pharmaceutical exhibition and Annual Dinner.
While the A.G.M. is the ruling body the Executive does the groundwork of formulating policy. It does so at its regular formal meetings, informally at impromptu meetings and on three occasions it has held fruitful think tanks.
Let's begin in the middle. The scene is Mount Juliet Hotel "I'm sorry" said the receptionist "there's nothing we can do" Shock. Six weeks before our October 1994 A.G.M. in Mount Juliet the booking was cancelled. Insistent probing disclosed the fact that the A.G.P. had been described as a "disreputable" group by persons whose identity we have been unable to establish. The hotel however welcomed us when they discovered that the Irish Pharmaceutical Union, the Dental Union, the Veterinary Union and the I.H.C.A. were attending the presentation of our withholding tax case.
That meeting convinced the major organisation that our case was exceptionally good, in fact, almost certain to succeed. There general councils pledged financial support. The I.C.G.P. later accepted also the soundness of the A.G.P. case against the tax. It could not under it's rules offer finance but it did offer support. This turned out to be disappointingly faint.
Enter the I.M.O. It informed the inter-professional group. The I.P.G. comprised the four bodies mentioned above and about ten other professional groups) that our case was weak and not worthy of support and that the I.M.O. had a better case. A further meeting of the I.P.G. was held two weeks later in November 1994 at the I.M.Os. insistence to hear the I.M.Os. case. The I.M.O. failed to attend that meeting.
In 1995 the I.M.O. campaign against our case continued. A series of meetings across the country called by the I.M.O. on another topic was used by them to rubbish the A.G.P. case. They not only did not know what our case was but they failed to respond to our correspondence. The meetings unsurprisingly failed to dispel the whiff of "disrepute" or danger supposedly attached to the A.G.P. Some complimentary remarks about the author of this piece were not heard at some of the meetings.
The Revenue Commissioners fought hard to scupper our case. Dr. O'Connell, whose name was known to the Revenue, had his tax returned and so his case fell. (There is rumour that cases taken by individual barristers were similarly defused). My name was kept secret until Judge Barr on the A.G.Ps. application in the High Court ordered a judicial review of "this iniquitous tax". Three days later the Revenue reimbursed my confiscated tax with interest. However their ploy did not work on this occasion as we already had the court order.
The case was taken and won emphatically by the A.G.P. with a special fund of £45,000. Our collection target had been £75,000 to protect me against loss. I waived my right to withdraw despite the shortfall as the case was so strong and despite the disappointment that only 17% of G.M.S. G.Ps. made a financial contribution.
Michael Daly, Thurles
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