A DEFUNCT DOCTORS’ group at the centre of a leaking controversy involving Leo Varadkar claimed that it was coming under financial pressure because it had not seen the contract shared by the then-Taoiseach with its former president.

The National Association of General Practitioners (NAGP) went into liquidation last year, just weeks after Varadkar shared a draft contract between the government and the Irish Medical Organisation (IMO) with NAGP president Dr Maitiú Ó Tuathail.

In a statement on 29 April 2019, the NAGP claimed that many of its members were waiting to see a copy of the contract before renewing their subscriptions with the association, resulting in financial issues for the group.

However, a statement from Varadkar on Saturday revealed that he provided a copy of the full agreement to Ó Tuathail some time between 11 and 16 April 2019.

The Tánaiste has since come under fire for sharing details of the contract with Ó Tuathail, news of which was first reported by Village magazine at the weekend.

Ó Tuathail said last night that it was “wrong” that the NAGP would not have seen the draft contract agreed by the government with the IMO.

However, it’s understood that then-health minister Simon Harris was not aware that Varadkar had shared the document and the Tánaiste will face questions in the Dáil about the leak tomorrow.

The NAGP went into liquidation weeks after the contract was shared, for reasons which were separate to the leaking of that information.

During its short life-span, the group was a constant thorn in the side of successive Fine Gael governments, and boasted to have more than 2,000 members at its peak.

And despite folding last year, its role in the current storm enveloping Varadkar befits an association whose existence was book-ended by controversy.

In fact, it was also details of a contract which hastened the NAGP into existence in July 2013.

Then, the controversy was about the retirement of the IMO chief executive George McNiece, whose lavish €20 million pension fund (which was later halved) angered many of its members who were feeling the bite of a deep recession.

Doctors were particularly aggrieved that their subscription fees would fund McNiece’s retirement at a time when GPs were struggling with cuts introduced by the Government under Financial Emergency Measures in the Public Interest (FEMPI).

Although the IMO sought to quell the controversy by halving McNiece’s pension entitlements and initiating a review of how such a contract could be agreed in the first place, many GPs remained disaffected by the representative group.

Disenchantment led to a slew of resignations from the association and the eventual formation of the NAGP, a new group promising to be an alternative and stronger voice for GPs.

The group’s membership gradually increased over the next year or so, and by November 2014, it claimed to have 1,200 members – almost half of the 2,500 working GPs in Ireland at the time.

During its period of growth, the NAGP established a strong media presence through high-profile events and claims, organising the first ever street-demonstration by Irish GPs and attacking former Fine Gael TD James Reilly as the worst health minister in the history of the State.

Policy statements

As well as media savvy and the promise of a fresh start following the McNiece controversy, the NAGP made a conscious effort to set itself apart from the IMO.

From its formation, the group adopted different stances to its rival association on various Government proposals, and regularly highlighted the issues affecting GPs in their day-to-day work.

As well as mundane problems like long waiting lists and even longer working hours, there were also more striking claims from the association that GPs were being attacked by patients or that a chunk of Irish doctors were unhappy with their choice of career. 

Meanwhile, the NAGP sought to further consolidate its membership after its formation with occasional attacks on the IMO, painting its rival group as an organisation unaware of the issues affecting GPs.

In November 2014, NAGP CEO Chris Goody claimed that GPs had not been made aware of a system which enabled doctors to renew medical cards for up to 12 months.

The system was mentioned in an agreement between the HSE and the IMO in 2011 but not widely communicated to GPs until it was announced by Varadkar as Health Minister in 2014. For its part, the IMO was also unaware of the new system at the time.

The following year, the NAGP strongly opposed proposals to introduce free GP care for children under six – plans which derived from an agreement between the Department of Health and the IMO – claiming it would significantly increase the workload on doctors.

That stance eventually landed the NAGP in trouble with the Competition and Consumer Protection Commission, who contacted the group with “grave concerns” that it could be anti-competitive to patients.

But the group’s most controversial position followed the result of the abortion referendum in 2018, when the group passed motions calling for an “opt-in” provision for doctors to provide abortion services, and for onward referrals not to be compulsory.

Those calls drew criticism from then Health Minister Simon Harris, who said the NAGP’s stance on referrals in particular “[flew] in the face of care and compassion”.

Around the same time, negotiations for a new contract between GPs and the State were becoming more of a priority for both doctors and the government.

The previous contract was more than four decades old, and cuts which had been introduced through FEMPI legislation were still impacting doctors.

However, in contrast to the IMO, the NAGP was not signed up to a framework for contract negotiations with the Department of Health or under the umbrella of the Irish Congress of Trade Unions. 

The group did join forces with the Independent Workers’ Union to allow them to directly negotiate on pay issues with the Department of Health in 2014.

But despite that licence to negotiate, the NAGP would remain outside contract discussions during its lifetime, something it would later cite as one of the reasons for its demise last year.

Board resignations

Although the association had attained a significant membership and had become adept at ruffling the feathers of politicians, it wasn’t long before the NAGP itself became unstuck.

In March 2018, two months before the abortion referendum, the association’s incoming president Dr Yvonne Williams resigned along with five other council members.

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It was subsequently reported that Williams and others had concerns about possible governance issues within the group, and members had become increasingly frustrated as questions went unanswered.

Williams was replaced by Dr Maitiú Ó Tuathail – to whom Tánaiste Leo Varadkar later leaked the IMO agreement and who told TheJournal.ie that the contract between GPs and the State was one of the biggest issues facing doctors shortly after his appointment.

Despite the circumstances surrounding the resignations of Williams and others, the NAGP continued its work over the next year, chastising the Government and expressing concerns on behalf of its members about working conditions as normal.

During that time, the association carried out a report into governance and remaining council members sought to introduce a number of changes which it recommended.

And despite the misgivings of many of its members, the NAGP even managed to rally hundreds of GPs to stage a protest outside the Dáil in February 2019 against the Government’s treatment of doctors and vulnerable patients.

Ahead of the event, Ó Tuathail claimed that the Government’s neglect of general practice would “lead to its extinction”. But in reality, the death knell was sounding for the association itself.

Voluntary liquidation

Two months after the Dáil demonstration, businessman Chay Bowes – who Ó Tuathail had asked to review the NAGP’s books and records – delivered a report to the association’s directors and council members about its financial governance. 

On 28 April Ó Tuathail, along with the entire national council of the organisation, resigned in response to the report. He said he had “grave concerns with regards to the governance of the organisation and cannot continue as president as a result”.

A subsequent statement from the NAGP confirmed the resignations.

Curiously, in the context of the current controversy involving Leo Varadkar and the leaked IMO deal, the statement also blamed ongoing uncertainty over the State’s new contract with GPs for the turmoil it found itself in.

“It has become evident over the past year that this Government will never allow the National Association of General Practitioners to sit at the negotiation table,” it said.

“It has also become evident that the Irish Medical Organisation and Department of Health enjoys a unique relationship.

“Many GPs are waiting to see the details of the new offer before they renew their membership subscription. This has created financial difficulties for the NAGP.”

The NAGP further claimed that its directors were attempting to put together a rescue package that would allow the organisation to survive and implement the findings of the governance report.

However, the business side of the association went into voluntary liquidation in May 2019.

Many would have assumed that would be the last controversy for an organisation that produced its fair share of dramatic headlines. The latest saga could see a few more written yet.