The government seems to have got itself into a muddle. On Monday evening, the health authorities signed an agreement with the doctors’ union, but soon after, the Social Policy Ministry said the agreement was not dogmatic and that discussions with the Medical Association of Malta were ongoing.

MAM has been arguing that doctor resources in health centres are overstretched and its directive, announced last week, was intended to concentrate resources in fewer health centres.

Social Policy Minister John Dalli, on his part, had said that while Malta’s shortage of doctors needed to be addressed, doctors also need to increase their output – a fair point.

Mr Dalli and his staff have spent hours trying to compute the supply and demand of doctors in health centres at different time periods, and presented their findings to MAM and to journalists on Thursday.

But they had signed an agreement on Monday, which said, among other things that health centre doctors will be expected to man the Floriana, Paola and Mosta health centres on a 24-hour basis, the other four health centres (Cospicua, Qormi, Rabat and Gzira) between 8am and 1pm, and just two of these centres between 1pm and 5pm.

The agreement said it was up to the Health Division to decide which of the four health centres would be manned by doctors in the afternoon. It added that doctors would only provide medical cover in two of these four health centres.

Despite the agreement, Mr Dalli said on Thursday that he would not accept a reduction in doctor services in health centres, which is baffling, to say the least.

So now the government seems to be unwilling to honour the agreement (evidently, that’s what the ministry meant by “it is not dogmatic”) and MAM is planning to issue new directives to health centre doctors.

The bone of contention seems to have been caused by point four of the agreement, which states: “The parties further agree to enter into discussions on: future changes in work practices including possible changes in the implementation of point five; and farming out of general practitioner services”.

But the fact remains that point five, which is the new schedule for health centre doctors (explained earlier), forms part of the agreement, and as MAM president Martin Balzan pointed out, a new agreement between the two parties would have to be reached for changes to the new schedule to be made.

In a very short reply to questions that this newspaper sent yesterday, the ministry said the health authorities are still ready to enter into serious discussions with MAM on “the implementation of the agreement”.

So it is point four and its interpretation that has caused the muddle. Who knows if the ministry will again attempt to farm out services to the private sector (see story on page 1) should MAM issue similar directives to those announced last week?

At this point, the government has no choice but to honour its agreement with MAM if it truly believes that people’s interests should come first.

As for doctor resources in health centres at night, Mr Dalli has claimed that MAM keeps insisting that it would not accept having the complement of doctors cut down during the night.

Asked whether health centre doctors get paid extra at night, MAM said they do not. But the fact is that the demand in health centres reduces drastically at night. Is this what makes the subject such a sensitive one?

In this sense, despite the MAM-government agreement muddle, Mr Dalli has a point in saying that resources should not be wasted, and that if doctors work whenever they are needed, there would be a sufficient manpower in the seven health centres.