The doctors' union, the IMO, says it is gravely concerned at indications that the Governments may force GPs to sign up for the new under sixes contract or else face losing their existing child medical card patients.

IMO GP Chairman Dr Ray Walley said suggestions that this might be the case would indicate that the Government had changed its policy on the under sixes deal.

"The Government seems to be reversing its previous stance that GPs would be under no obligation to sign up to the new contract," Dr Walley said.

He said GPs were now being threatened with losing their existing under sixes medical card patients if they did not take part in the new scheme, which would provide free GP care for all children under six regardless of income.

Minister for Primary Care Alex White recently invited the IMO to talks aimed at ending the long-standing impasse between the Department and GPs over the under sixes scheme. Legislation on the new scheme was agreed by Cabinet yesterday.

The main sticking point to date is the fact that the Government says it cannot directly negotiate fees with the IMO due to competition law restrictions. The IMO says this is not the case, and says direct negotiations on all issues, including fees, must take place before it can recommend the scheme to GP members.

The IMO and GP groups also want major changes to a draft contract recently produced by management for the operation of the under sixes scheme, which GPs claim is unworkable.

The union is now seeking clarification from Minister White on whether or not GPs would face the choice of signing up to the new deal or losing medical card patients.

"This approach suggests that the Government has no interest in negotiations and is more interested in effectively coercing GPs to sign up or else.  This may constitute a breach of the constitutional rights of GPs to earn a livelihood and it runs completely against the legally binding GMS contracts already in place between GPs and the HSE."

"If the Government proceeds on this basis, they will make a difficult situation an impossible one," Dr Walley added.

He said the IMO wanted to see the draft legislation, which has not yet been published.