History of the A.G.P.

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.

He was a tremendous branch Secretary of the Tipperary branch and a good friend of this scribe. I know from him that the hardship caused by the tax was not fully understood by the I.M.O.

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 in 1990(?) 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 as far as I Am Aware.

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.

There is an odd echo of this today with I.M.O. having "talks" with the V.H.I. despite it's A.G.M. forbidding negotiations with the V.H.I. 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, a post he holds with great dedication and distinction to this day. Seaghan is a past President of the I.M.A. and the founding President of the Medical Union.

In passing I should mention the A.G.P. has on its rolls other former presidents of the Medical Union namely the late Dr. Eoin O'Sullivan who gave us much encouragement and Dr. Tom O'Callaghan who is active on our Executive and a valued dispenser of wisdom and guidance (and not a few jokes).

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" have now become the single question of proper entry and exit arrangements for the G.M.S.

The Alliance of Family Doctors was born of these determined suitors, the A.G.P. and the N.A.I.G.P., in the Davenport Hotel in Dublin on the 24th April, 1998.

The Alliance of Family Doctors has achieved a salving of wounds between different sections of General practice. It achieved Trade Union Status on the 13th September, 1999.

At present its planned affiliation to S.I.P.T.U. is being delayed by the I.M.O. It seems odd that one Trade Union should attempt to interfere with the legal and reasonable actions of another, or perhaps it is understandable. The Alliance has over 1,000 members. Affiliation to S.I.P.T.U. will give us instant access to a negotiating licence. S.I.P.T.U. has 250,000 members and will provide the Alliance with the necessary facilities and skilled negotiators to make the Alliance the most powerful group negotiating for G.Ps. The Alliance will remain entirely separate and independent of S.I.P.T.U. The advantage for S.I.P.T.U. is of course a foothold in negotiations with the Department of Health.

All in all it is an exciting time for general practice. The A.G.P. and now the Alliance of Family Doctors continues to offer the G.Ps. the prize of G.P. unity in one powerful body. This should be linked closely with overlap on ruling councils with the I.C.G.P. That body seems to shrink from the prospect of a G.P. only body, albeit with two heads academic and negotiating, and seems heavily influenced by the I.M.O.

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.

The Executive Committee is led this year by Dr. Patrick Crowley who succeeded Dr. Michael Daly as Chairman who in turn succeeded Dr. Mary Grehan, Founder. Both Dr. Grehan and Dr. Daly served for six years but in future one or two year terms seem more appropriate. Long standing executive member and current vice-chairman Dr. Michael Fay is expected to be elected Chairman in October with Dr. Terry McGuire being tipped to take his place. The excellence, diligence and importance of their work for the A.G.P. have made Dr. Jim Stacey, our Hon. Treasurer, and Dr. Seaghan Ua Conchubhair, our Hon. Secretary, seemingly permanent fixtures. Each of them would otherwise long ago have been honoured with the chairmanship.

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. These took place at the Hodson Bay Hotel in 1997, in Castletroy in 1998 and in Fermoy in April 2000.

Our policies do not greatly differ from those of the College, which is hardly surprising. However, orderly and fair entry and retirement from the G.M.S. is a top priority. One in one rotas is a top priority and we await the result of a case in the highest European Court in this regard. We have a candidate waiting in the wings to take a High Court case if the European Court does not outlaw 168 hour per week contracts.

The Mental Treatment Act and its replacement is being closely monitored by the A.G.P. and we have been very active on this topic. We have published our policies on a family-friendly general practice which is of special interest to doctors who have care of families in addition to care of patients.

The V.H.I. is the current problem facing G.Ps. That unfriendly (to G.Ps.) organisation has been summonsed by the A.G.P. and we hope to have an interlocutory injunction against them. We can't simply have a rushed unilateral proposal from the V.H.I. imposed on primary care. G.Ps., patient groups, health boards and the Department of Health all need to get together to decide the future of primary care. Then will be an appropriate time for the V.H.I. to enter a less chaotic scene.

Another policy the A.G.P. is supporting is that new work must be agreed with G.P. and fees agreed before implementation. A case in point is the new work sought of G.Ps. by Nursing Homes. The hospital-type records the law demands of Nursing Homes are over and above the records and prescriptions and advices given by G.Ps. and a fee for G.Ps. is required.

Fee-charging is an excellent strategy for the prevention of unnecessary extra form-filling. I must finish this tract with a little praise for the I.M.O. There have been excellent improvements in certain areas like social welfare fees, maternity, some vaccination fees and out of work fees. G.Ps. are in the majority of cases reasonably content. However those G.Ps. on the margins with declining G.M.S. lists and little opportunity for private practice, those G.Ps. who are excluded from the G.M.S. all us G.Ps. who are excluded by varying extent from access to Hospital technology, the neglected fee per item G.Ps. - all these groups and more must have their interests looked after.

©2009 All Rights Reserved.   Website Design: Ambit Ireland