FAMILY doctors who refuse to sign a new contract providing free visits to all children under six are being threatened with a €12m wipeout in state income.
Health Minister James Reilly has told GPs who refuse to sign the controversial contract that they will be cut off from all HSE payments for treating the under-sixes.
The rebel doctors now face a significant loss in state income if they continue to hold firm.
New legislation published yesterday ups the ante in the stand-off with doctors who have so far refused negotiations with the Government.
It outlines how a new GP card for children under six will be given to all families, regardless of income, as long as they have completed an application and proved their child's age.
It will entitle the majority to free GP visits only – but those who qualify for a full medical card will continue to get the extras, including medicines.
The changes mean that parents whose child currently has a medical card or GP card will need their GP to sign the contract. Otherwise they will have little option but to leave their family doctor, and register with another medic who has signed the contract.
A parent could still pay a private fee for a GP to see their child, but would be highly unlikely to do so if another local doctor was offering the service for free. The move also threatens to create a bureaucratic nightmare as the HSE struggles to deal with the issuing of around 420,000 new under-sixes cards by the summer as promised.
The Government has €37m to fund the extension of free GP care to all under-sixes.
The doctors' union, the Irish Medical Organisation, said it was "appalled" at the proposed legislation, describing it as "draconian" and "an attempt to unilaterally rewrite the relationship between GPs and the HSE".
GP spokesman Dr Ray Walley said the aim was to drive through an oppressive new contract for family doctors which would "destroy the very fabric of the GP service", leaving more surgeries financially unviable.
Doctors fear they will be overwhelmed with a surge in visits from under-sixes whose parents will no longer face any financial barrier, with implications for the kind of care they can give to sick and elderly patients.
The Government wants to extend free GP visits to 240,000 under-sixes.
It plans to secure legal power to stop rebel doctors holding on to the other 180,000 under-sixes who have a medical card or GP visit card.
The IMO has so far refused invitations to enter negotiations on the new contract because they are precluded from any talks on fees under competition law.
The Department of Health defended the proposals, saying the introduction of "one tier" of free GP care for all under-sixes meant that all doctors would need to sign the new contract.
While 240,000 children who are being brought into the net will be confined to free GP care only, and not receive extras such as medication, those who are currently eligible for medical cards will continue to receive the extended benefits.
A Department of Health spokesman said: "It is important to be clear that the other medical card services of under-sixes will not be affected."
The proposals are set to be hotly debated by angry doctors at the AGM of the IMO this weekend.