Under the Medical Carpet

The Auld Squint.

When Leopold Bloom was on the way to the funeral of Patrick Dignam at Glasnevin Cemetry, a fellow occupant of the carriage remarked, at the crumbs and damp seats. “Corny (the funeral director) might have given us a more commodious yoke:” To which another replied “He would have, if he didn’t have that squint about him.., if you know what I mean?”

‘Squint’ in lay-terms might be described as one eye looking at you and the other looking at your shirt pocket. Joyce’s use here, is in reference to duplicity or insincerity; the ‘all too human’ ability to be truly at variance with the ideals or persona that is ones ‘public Gar’ so to speak. In post colonial cultures, this ability to appear sincerely aligned with the presiding social order, or mores of the day, is a talent that we have had 600yrs of perfecting. Our finely polished insincerity may be one of the reasons we Irish make some of the best performers in the world, and may explain why we are so capable of inventing a story to others, and particularly ourselves.

Sometimes (but not too often) it is refreshing to lift the carpet of the Irish Medical Establishment and see the sweepings underneath, awaiting posterity and the review of a more sober and focused generation. Beneath that well-worn Axminster we may find some of what the crooked eye was really focused on all the time. A most recent addition was the 25 million retirement package agreed with the former CEO of the IMO, whilst the present sale of GMS contracts by the ICGP is awaiting the swish of the broom so that it too might join the pile beneath the pile.

What is perhaps most telling about the McNeice package is not the fact that the initially agreed 25million handshake was magnanimously negotiated down to a modest 10 million; but rather the fact 90% of the membership of the IMO have voted with their cheque-books and membership dues to ‘stand by their man’ and to pay the piper’s plentiful pension for many years to come. Ethics and intelligence are perhaps not as mutually inclusive as we might like to believe?

In recent years access to a GMS contract was the remit of the HSE. After much ado about nothing, and the intervention of the Competition Authority, reform arrived in the guise of GMS contracts being made available to all GP’s on the Specialist Register. The Medical Council (in the spirit of all that is institutionally Irish) have abdicated responsibility for determining eligibility for the specialist register to the ICGP, thus allowing the college to become the new GMS gate keeper, and the Medical Council to act in the less-work and more familiar role of a rubber stamp at the end of the process.
With a curtsey to the ‘God of the Markets’, the ICGP has turned this nod from Council into a very lucrative financial wink, and they have begun the harvest of the millions. In Ireland whenever reform is attempted, the auld squint invariably turns a noble idea into a good business plan. As such the ICGP have unveiled their ‘Alternative Route’ to membership of the college (and the all important GMS contract). The fee for suitable candidates who might turn up at the back door of Lincoln Place, is a mere €7000, and one doesn’t even need a brown envelope.

Behind the scenes, driving the venture forward, is the growing reality that Lord Reilly has some form of Universal Health care in the pipeline. As such, the dogs on the street know that if you are not a member of the oxymoronic ‘Specialist Register for Generalist Practice‘… then you are likely to be left in the cold when the Minister’s carves the cake of universal ‘free’ GP care.
In addition to financial extortion, part of the mandatory requirements for the ‘Alternative Route’, is having ones BCLS certification up to date. Of course on the surface this seems a wonderfully enlightened idea.. Yet through the straight eye, one sees that up to date BCLS certificates are not a requirement nor are they held by the vast majority of practicing GP’s and college members. One rule for the members and another for the paying plebs.. sounds bankingly familiar? My own BCLS has lapsed since moving from New Zealand where such certificates form a mandatory part of a relevant ‘CME’ program, one that is less about institutions turning regulations into profits.

This heavy handed ‘application fee’ is being levied upon those GP’s who are the most financially vulnerable within the entire profession, as we are deprived of the ‘benefits’ of a GMS contract. Going after the most vulnerable is apparently as familiar to Irish institutions as it is unfamiliar to their mission statements.
 
The ICGP has declared that around 250 Doctors are likely to apply for the AR. In truth the figure could be between 500 and 1000, representing anywhere between 3 and 7 million of an income stream for the college. This coupled with the mandatory CME payments that must be made to the ICGP by all GP’s in the state, would certainly mean that the college CEO should be well placed to demand from his indentured shareholders a similar package to that of the former IMO chief. ‘Business as usual’ one might say.

Perhaps one day we might lift that old carpet and apply the hoover. After which the dust might settle and a few of us might begin to see straight once again.

Many thanks to the 39 who voted for me in the MC elections ‘Tiocadh ar La’ as the Shiners used to say!’