General Practice in the 21st Century is going to show considerable changes from General Practice over the past one hundred years.

In any survey of patients their satisfaction with their G.P has remained consistently high and it is important that we do what we can to maintain the confidence and satisfaction of the General Public. As to how this can be done while improving our quality of life and the quality of our family is one of the biggest challenges we are facing.

We do not and cannot practice in total isolation. The General Public expect and are entitled to many services which will continue to be funded from Public Funds. Those less well off will continue to deserve free medical care. We need to work in co-operation with the Dept. of Health & Children and the Health Boards in providing these services.

However the GMS as we have known it has been changed by the recent over 70's deal. No longer is free medical care decided by a persons ability to pay. The forthcoming General Election will see "Free medical care" as a political football being played between various parties each promising "free care" to different age groups.

While continuing to express our dissatisfaction with the inequity of the over 70s deal which discriminates against those on middle to low incomes, I acknowledge that it was purely a political decision. As such I recognise the benchmarking fees agreed for the over 70's and those in Nursing Home care are reasonable for the work involved.

I regret the haste with which the deal was commenced. Recently expressed difficulties with doctors retired from the GMS, who wished to continue in private practice, and with those working on the Fee Per Item contract would have been avoided with a little more time. They would also have been avoided if we the AGP who are all active in General Practice had been involved in the negotiations. Similarly our voice must be listened to in the changes that will take place over the next few years. Professional negotiators can never fully understand the needs and concerns of those at the coalface as we the A.G.P. are.

We GP's are also under attack from within the medical profession. When the Health Boards arranged long-term accommodation in private nursing homes for geriatric hospital-bound patients, a senior geriatrician in the I.M.O. made a strong attack on the standard of care these patients would receive in these nursing homes. This was a direct attack on GP's such as myself who are now caring for these patients.

Two weeks ago the Chairman of the Hospital Consultants Association stated that one of the main reasons for over-crowding in the A&E Departments was the non availability of patient's own GP's. While accepting that a small number of patients go to A&E for second opinions, the major hold-ups are caused by the non availability of beds for seriously ill patients, many of whom are referred to A&E by their GP's who have no direct access to hospital beds.

I do not believe that these consultants have a problem with GP's but I do resent the fact that when the Consultants wish to fire cannons at the Department of Health & Children they use their GP colleagues as the cannon ball.

If Doctors are seen to be in dispute with each other the Department will be able to play up one against the other in sharing out resources.

These are some of the reasons why a strong GP only voice is needed. However, we do need new and also some younger voices to be heard within the Association. The NAIGP were very vocal a few years ago. Many of their active members having obtained entry to the GMS have stepped back from the limelight. I would earnestly ask these and other concerned GP's to come forward again and get involved with the AGP as the more voices that are heard the broader the consensus we can present.

We the AGP can and will present a strong voice. The attendance here last night and again today is proof of our standing within the GP profession and of our determination to represent and speak out clearly for General Practice in the changing times ahead.

20 October 2001

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