The circumstance and atmosphere which awaits Minister Alex White's presence this morning at the Irish Medical Organisation's (IMO) AGM is far from ideal.
Alex White became Minister of State with responsibility for Primary Care in controversial circumstances in September 2012 after the resignation of fellow party member Roisin Shortall.
Shortall was shafted by both her Fine Gael and Labour colleagues in the aftermath of the primary care centre farce involving minister James Reilly and stood down on a point of principle.
Mr White was considered a steady pair of hands to enter the den that is health politics and took the promotion.
On taking up office in March 2011, the coalition parties committed to free GP care for all by 2016, with a staged approach to delivering it, first to those with long-term illnesses by March 2012, then to those on hi-tech drugs by March 2013. Neither of these milestones was achieved. The excuse was that it was not legally possible to extend free GP care to these sick people.
A new plan was hatched, formally announced in Budget 2014, to start the plan for free GP care for all with children under six by mid-2014. There was no detail then or now as to how the remaining two million plus people will gain free access to GP care by 2016.
The last time Mr White met officially with the IMO was on January 31, the day he published the draft GP contract to facilitate the introduction of free GP care for all children aged under six. Since then Mr White has made repeated calls for the doctors to come to the negotiating table to talk about the draft contract but, crucially for GPs, not what they will be paid.
Under competition law, negotiating fees is not allowed, although this is being challenged in a High Court case starting on May 21.
GPs are nearly unanimous in their vociferous opposition to the new contract. They make the point that they will be overwhelmed by unnecessary visits of worried parents of well children. While the number of visits of under sixes will increase their workload, the evidence does not back up their claim – charging for essential care (and medicines) deters as much necessary as unnecessary use. And there are conflicting figures as to how much the increase will be, but it probably won't be anywhere near the 750,000 extra visits as predicted by IMO GPs. GPs see the new under-sixes contract as a Trojan horse for an entirely new contract which includes prevention and the management of chronic diseases. And they are right about that. They do not want well children to have free access when sicker, poorer people do not.
Yet, both the IMO and the Irish College of General Practitioners have called numerous times for universal access to GP care, for more of a focus on prevention, early intervention and the management of chronic diseases, for better resources for primary care.
And resources are important. A whopping €160m has been cut from public payments to GPs since the onset of the economic crisis through the Financial Emergency Measures in the Public Interest (FEMPI) Act. There is no doubt but GPs have had a double blow to their income due to fewer private patients and more public patients for whom they are paid much less. Also, many GPs who invested heavily in buildings and property during the boom are finding it hard to keep up payments.
GPs consistently make the point that they currently provide services they are not paid for, which is true, and that this is no longer sustainable. They see here and now as a critical juncture in the future of the delivery of GP care in Ireland. And it is.
This week the Government published the Health (General Practitioners) Service Bill, which is the legislative basis for free GP care for under sixes. The bill does two things. It pretty much puts FEMPI on a permanent footing allowing the minister to change fees (downward) at any time. Are we not told by our political masters that the crisis is over?
Plus, the bill requires that GPs who currently care for under sixes with medical cards, sign up to the new contract if they want to continue to be paid for them. This, in effect, is putting a gun to the heads of GPs and threatening them with the loss of another €20m of public money if they refuse to sign the new contract.
Presuming the timing was purposeful, issuing the legislation this week could not have created a more hostile environment for Mr White's appearance at the IMO AGM.
One solution that would allow Labour to deliver its promise of free GP care for under sixes would be to put on hold the current legislation and contract, to extend GP-only cards to all under sixes by June and give the time and space needed to negotiate a new GP contract for the whole population.
This new contract could bring about the much-needed change so that patients are empowered to look after their own health and manage chronic diseases in partnership with GPs and primary care staff. The new contract could even deliver free GP care at the point of access for the whole population.
But this will require more resources, not less. It also requires some political nous which seems largely absent in this, as in most, health policy debacles.
Ramming through the proposed legislation and contract will result in a stand-off – a stand-off that will be very costly, not just in terms of the very existence and future of GP care, but critically for patients' care.
There is still time for Mr White to show some political savvy.
At the end of the day, all disputes end in negotiation. Both sides have choices to make, to talk now or later after a prolonged, bitter, harmful dispute. The time to talk is now.
Sara Burke is a health policy analyst. She is a post-doctoral research fellow in Trinity College Dublin. Twitter @sburx