ON 6 APRIL 2019, the then-Taoiseach Leo Varadkar issued a press release to welcome a long-awaited agreement on a new contract with GPs across the country.
The €210 million deal, although not yet signed, marked a major step given the protracted nature of the years-long manoeuvering between the HSE, the Department of Health and the Irish Medical Organisation (IMO).
The previous General Medical Services (GMS) contract had been signed almost 50 years prior – in 1970. It didn’t cover such things as chronic disease management or maternity and paternity leave for general practitioners. Meanwhile, austerity cuts introduced after the 2008 financial crash through FEMPI legislation were still impacting funding.
On the government’s wishlist was a cost-effective extended list of services and free GP care for children under the age of 12.
Even launching the talks was fraught with issues because, as noted by Varadkar today, GPs are mostly self-employed contractors. Following the conclusion in 2014 of a High Court case centred on related competition issues, the IMO was determined to be the sole negotiating body on behalf of doctors in a framework agreement with the Department of Health.
Established in 2013, the National Association of General Practitioners (NAGP) was considered a rival representative group for doctors after pension pay-outs at the IMO had angered some members. However, the NAGP was not signed up to that framework with the department. It was also not under the umbrella of the Irish Congress of Trade Unions.
The terms of any agreement, though, would eventually be open to all GPs irrespective of the representative group they were members of. In 2019, the NAGP said it had 1,200 fully paid-up members.
With disparate groupings and such an outdated contract, the talks were difficult but ultimately proposals on the introduction of new service developments to include a chronic disease management programme, as well as a suite of reform and modernisation measures, were hashed out.
Today, Leo Varadkar rejected allegations that he acted unlawfully in providing the full details of the ensuing draft pay deal agreement to the NAGP in the weeks following that initial announcement on 6 April 2019.
Although the Tánaiste admitted that providing a copy of the agreement to the head of the NAGP was not best practice, a statement issued on his behalf by Fine Gael’s press office, argued that the majority of the deal’s details were already in the public domain.
Varadkar claims he shared the draft agreement with an aim to encourage acceptance of the agreement from the entire GP community, including those who were still members of the by-then embattled representative group. (The NAGP collapsed and went into liquidation in July 2019 following financial and governance issues.)
1/2 - The Green Party notes the statement from the Tánaiste following the revelations in Village Magazine. The party is calling on the Tánaiste to give a full and detailed account to the Dáil on the issue and to allow sufficient time for the statement followed by questioning.
— Green Party Ireland (@greenparty_ie) October 31, 2020
Tonight, calls have come from the Green Party and Labour for the Tánaiste to provide further details and to allow for more scrutiny on the timeline of events leading up to the spring and summer of 2019.
In August 2016, when the new contract was being mooted but was nowhere near completion, Health Minster Simon Harris said: ”I think it is absolutely essential that we have the new contract negotiated and I want to see the NAGP as part of that… what I am doing is saying very clearly that when we get down to negotiating the GP contract, which I expect to happen by the end of the year, that the NAGP need to be in the room.”
The fact that the NAGP had subsequently been omitted from the negotiations was raised repeatedly by TDs. In the years that followed, queries were often made about the level of engagement with the group on any proposed deal (the Department had said it would be consulted, but not negotiated with).
On June 28 2018, then Fianna Fáil health spokesperson Stephen Donnelly again asked Simon Harris about the matter.
The Wicklow TD noted almost two years had passed since the Minister’s August 2016 remarks and that the GP negotiations had been ongoing for a number of months.
Donnelly said the NAGP, on foot of the above promise, had written to the Minister repeatedly “but it cannot even get a letter in response to say when he expects its representatives to be in the room”.
“It has received one letter from the Government stating that at some point in the future, the Government will engage with the association.”
Donnelly asked Harris if the Department had fallen short of the standards and level of engagement required and he asked if the minister would give the group a clear timeline for when it could negotiate on behalf of its members.
Harris responded to say he would engage with the NAGP on the contract negotiations, adding that he had also spoken with leaders of the group in relation to the possible deal:
“We negotiate with the Irish Medical Organisation but I did say, and I stand by what I said, that we must have an inclusive process that enables other organisations to put forward their ideas.
Incidentally, the NAGP has some very good ideas. The NAGP will be formally consulted and it received correspondence to that effect. I had a number of conversations with leadership figures in the NAGP, as I do with all stakeholders across the health service. They will hear about their opportunity to contribute to the process in the coming weeks.
He acknowledged that the NAGP “is also anxious to be involved in discussions about reform of the GMS contract”.
“I have indicated my willingness to consult the association formally on the many issues facing general practice and I anticipate that arrangements in this regard will be made in the coming weeks.
“My Department has written to the NAGP in this regard pointing out that we would commence discussions and negotiations with the IMO, which is a member of ICTU. That is how the State does its business on many contractual issues.
However, the Department also stated that we would also provide the NAGP with an opportunity to contribute meaningfully to that. That will happen in the coming weeks and I have put that in writing to the NAGP.
The 2016 drive to get a new GMS contract faltered but it again became a priority for government in 2018 following a spate of stories that medical card patients were being refused reimbursements for blood tests taken by GPs.
With talks gaining momentum in 2019, the NAGP question arose again.
On 6 February 2019, Senator Colm Burke told Harris at an Oireachtas Health Committee hearing that members of the organisation would be protesting later that day as they did not feel part of the ongoing negotiating process.
Harris said it was a “fair point” but that his department engages with the IMO on contractual matters.
“There is a role for the NAGP to play in terms of being consulted and involved, but the negotiations are with the IMO,” he said.
He also said he did not want to get into the “medical politics of it” because “it makes the politics in which we are involved seem very tame at times”. There are different organisations “with, perhaps, different perspectives and rivalry”, he remarked.
He repeated how he was happy to explore consultative roles for other organisations.
The closing
Following what was described as “detailed and intensive engagement” by the government, the talks finally concluded on Wednesday, 3 April 2019 with the new GP contract agreed between the IMO, Department of Health and HSE.
On Friday, 5 April, the Irish Medical Organisation (IMO) issued a press release which announced details of the negotiated agreement. The body said it had secured €210 million in increased funding for General Practice over the coming years.
In the statement, Dr. Padraig McGarry, chair of the IMO GP Committee, made comments on the deal.
“This is an important step towards investing in General Practice and valuing it as a vital part of the health service. It will do two things; restore the draconian cuts imposed on GPs and bring new and much needed funding to deliver new services to patients in the community,” he said.
The press statement also outlined some of its key elements:
McGarry confirmed that the controversial FEMPI cuts imposed during the financial crisis would be reversed in four stages, from July 2019 to January 2022.
He also outlined the next steps would be a series of consultative meetings for members and a ballot of GP members on the deal.
The above-mentioned statement was issued by government on Saturday, 6 April with Varadkar and Harris welcoming the agreement with the IMO on a major package of GP contractual reforms “which will benefit patients and make general practice a more attractive career option for doctors”.
The release did not contain much in the way of granular detail about what the draft contract contained.
As revealed by the Village today and later confirmed by Varadkar himself, some time between 11 and 16 April 2019, the then-Taoiseach provided a copy of the full agreement to Dr Maitiu Ó Tuathail, president of the NAGP.
On the last day of that period, 16 April 2019, a debate on General Practitioner Contractual Reform took place in the Dáil. During the proceedings, Harris said:
“I am pleased to be here this evening to update the House on the outcome of the recently concluded general practitioner, GP, contract talks. I genuinely believe this represents a major step forward in terms of the implementation of Sláintecare, with increased resourcing for primary care and widening the range of healthcare services available in the community…
Owing to the range and complexity of the issues to be discussed, the engagement process took a significant amount of time and effort by all parties involved. Following detailed and intensive engagement, the talks finally concluded on 3 April.
During the same debate, the Fianna Fáil health spokesperson (and now Minister for Health) Stephen Donnelly said it was good to get some detail of the deal, given that the exercise had been very frustrating to date.
He raised concerns, as did other party spokespeople including Labour’s Alan Kelly, Social Democrats’ Róisín Shortall and Sinn Féin’s Louise O’Reilly, that they had not seen sight of the agreement ahead of the debate.
“The outline of the deal was agreed about two weeks ago. The GPs have not seen it, the public have not seen it, and we have not seen it. We are being given pages of facts and figures now. We have not seen them before. I have asked the Department for them and I have asked the HSE. We have been denied access to any of the detail. We are sort of expected to stand up here now and respond,” Donnelly said at the time.
Donnelly said health spokespeople for the political parties should have had the information on the deal ahead of time, “days in advance”, he said, adding:
In fact, we should have had it the day after it was agreed with the IMO.”
Sinn Féin’s Louise O’Reilly said during the debate that the deal was done two weeks ago, saying “it is unfortunate that I did not have more detail in advance of the debate”.
However, former Independent TD and GP Michael Harty revealed he had seen more details of the deal.
The County Clare deputy told the Dáil he had a copy of the agreement in his possession, and said the agreement was “still under discussion at IMO meetings”.
“I may have an advantage, being an IMO member, in that I have in my possession a document which outlines, in broad brush strokes, what is contained in the agreement,” he said.
Former Wexford TD Mick Wallace said during the debate:
“Only 20% of GPs are IMO members, 40% are members of the NAGP, while 40% are not members of any union. This new contract has been negotiated without the input of the vast majority of GPs or their representative bodies. The vast majority of GPs have still not seen the new GP contract. Only one-in-five GPs have seen the contract via the IMO.”
The health minister clarified at the end of the debate that GPs had begun a process of intense consultation, which took place in Dublin the night previous (15 April).
It would be another month before the full detail was announced. The Department of Health published the entire text of the IMO deal on 17 May 2019.
Results of the ballot of IMO members were announced on 22 May 2019 with 95% of GP members of the IMO across the country supporting the signing of the contract.
The timeline from 2016 to April 2019 will inform the events of the coming days with most opposition parties – and the Green Party and some Fianna Fáil backbenchers – calling for more scrutiny of what happened and when.
Today, Varadkar’s statement said that the provision of a copy of the agreement by the Taoiseach to the president of the NAGP “was honouring a political commitment previously made by the Government”.
In a statement issued on the Tánaiste’s behalf, it was noted that the Fine Gael leader accepts that the provision of the agreement by an informal communication channel to the President of the NAGP “was not best practice and he regrets that he did not ensure that it was provided in a more appropriately formal manner”.
“There was however, nothing in any way unlawful about the provision of the Agreement to the President of the NAGP,” said the statement.
“The provision of the agreement to Dr. Ó Tuathail requires to be seen in the context of the potential unfairness of one representative body for General Practitioners (the IMO) having access to the Agreement at a time when the other representative body (the NAGP) did not,” it added.
The statement went on to deny Varadkar’s actions amounted to a breach of the Official Secrets Act, 1963; the Criminal Justice (Corruption Offences) Act 2018; the Dáil members’ Code of Conduct 2002; the Office Holders’ Code of Conduct 2003; or data protection legislation.
There have been calls now for the Tánaiste to answer questions in the Dáil on the matter – described by the Sinn Féin leader Mary Lou McDonald as a scandal – on Tuesday.
In a strong statement from the Labour Party, Enterprise spokesperson Aodhán Ó Ríordáin said the then-Taoiseach provided a confidential document to the NAGP despite neither having a formal role in agreement.
“The Tánaiste must commit to answering questions in the Dáil on Tuesday,” he said. “His carefully worded statement is padded out with information that is not related to the matter at hand. There are serious issues that he must address. Why was he meddling in a process by providing a confidential document to a competitor body that had no role in approving the GP agreement?”
Meanwhile, the Green Party (Fine Gael’s coalition partners) has increased the pressure on Varadkar.
In a statement this evening, the party said: “It is clear from what has been revealed that the passing on of sensitive information in this manner was not appropriate. The timelines and the full impact of the disclosure on all involved needs further scrutiny.”
Despite having had contact with the Tánaiste today, Taoiseach Micheál Martin has remained publicly silent on the issue.
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