As I see it, the proposals for reform of primary healthcare, as set out in the recent government consultation document, have little chance of being realised.

However, as the title of the document proclaims, this is an occasion for consultation and as such it is not an opportunity to be lightly passed up. As a senior citizen and a retired doctor, I believe the matter is of high importance and deserving of reflection and suggestion from any quarter, whatever the outcome.

The basic premise of the document concerns the desirability of an efficient, national general practitioner service. I do not think anyone can disagree on this, though it is possible to argue that State intervention in a family doctor service may constitute "a threat to civil liberty", as a US senator put it.

We must tune in to what is going on in GP care on our own little island. Here, we have a most valuable resource - a large group of highly competent and dedicated doctors often short-circuited by a population who, at the drop of a hat, seek care in healthcare structures, like health-centres and hospitals intended for providing secondary and tertiary care.

The result is undue strain on these services, with the consequence of longer waiting times and waiting lists.

It also means the waste of a precious human resource which not only could serve the patient more personally and with more continuity, but could also act as a filter and protection against the abuse of health centre and hospital services.

However, recruiting the services of such a body of highly trained professionals comes at a price. One cannot expect to have a national, efficient, 24/7 GP service for peanuts. It is a venture calling for serious financing and, sadly, the aforementioned document gives no hint that it envisages a heavy outlay.

Nor is the major political criticism being made that the government is stealthily moving away from its trumpeted electoral programme of a 'completely free public health service' given any contrary reassurance in the document. What it can say is that the proposals are only at a consultation stage.

Let's consider now some of the content of the document itself. The heart of the matter, entitled 'Care Packages', is found under Section 5 of the document, which in all has eight sections and two appendices. In 5.1, the 'Core package of services to be provided by all registered care providers' is spelled out.

The 'registered care provider' - the family doctor with who one has to freely register - is expected to represent the sole link between a patient and any public health service he or she is considered to require. There are exceptions to this referral obligation and most of these fall under emergency and immediate care situations.

There should be little that is controversial in this except it is not pointed out that the cost of consultation and/or referral service being provided by the family doctor is to be borne by the patient, nor is anything said as to how payment is to be made and whether a tariff of charges is to be set up. Again, the counter reply may be 'this cannot be stated at this stage'.

Further under Section 5.1, medical information pertaining to a patient and/or discharge letters would become "immediately available" to the patient's registered GP. However, nothing is said about the accessibility to the patient of this information.

Under 5.4, much is made of the introduction of "a seamless IT system" for the transfer of a patient's medical information between hospital/health centre and registered GPs by electronic means. While such a facility should prove of immense benefit to the patient and his/her GP, and is possible with modern IT technology, most household internet users are aware of the problems of the internet.

However, all participant family doctors are expected to be 'IT trained' and proficient" and to provide themselves with 'the required level of IT equipment', while no mention is made of pilot schemes and induction programmes to ease GPs into a computer-based practice.

And so it is due to the detail in the proposals that consensus as required by MAM will in my view never be reached.

The leap in the quality of primary healthcare service currently available comes at a price, and the cost has to be shared to be sustainable.

The necessary political will to push through the major proposals made in the Consultation Document can only come about when the two major parties are agreed on this fundamental.