Billy Kelleher (Cork North Central, Fianna Fail)
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4. To ask the Minister for Health the key measures that will be implemented in primary care over the remainder of the Government's term in office; and if he will make a statement on the matter. [48346/13]

Billy Kelleher (Cork North Central, Fianna Fail)
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In this question, I am raising the issue of primary care services, rather than primary care centres. It is clear that general practitioner services are under great pressure at present. I received a letter last week from more than 50 GPs who indicated that they are not able to operate or provide the service they would like to provide. Continual cuts have been made in the context of the financial emergency measures in the public interest regime. There is no clear strategy for bringing forward the primary care strategy. I believe we have an obligation to support GPs in the delivery of the primary care strategy.

Alex White (Dublin South, Labour)
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The key measures that will be implemented in primary care over the remainder of the Government's term in office are the introduction of a universal general practitioner service that is free at the point of access; the introduction of a new GP contract; the phased roll-out of chronic disease management programmes; the development of the primary care workforce to facilitate the universal GP service and chronic disease management; and the continued development of the primary care infrastructure. The Government is committed to introducing on a phased basis a universal GP service by 2016, as an essential prerequisite for the introduction of universal health insurance as set out in the programme for Government and the future health strategy framework. As announced in the budget, it has been decided to commence the roll-out of a universal GP service by providing all children aged five and under with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. Additional funding of €37 million has been provided to meet the full-year cost of this measure.

The new General Medical Services GP contract will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. The formulation of the new contract will have regard to the constraints of Irish and EU competition law, particularly in respect of the setting of fees and allowances. The HSE is developing integrated chronic disease management programmes to improve patient access and to manage patient care in an integrated manner across service settings, resulting in best health outcomes, enhanced clinical decision-making and the most effective use of resources. The HSE national service plan and operational plan for 2014 will see a continued focus on the asthma, diabetes and chronic obstructive pulmonary disease programmes which are particularly relevant to primary care.

In 2013, primary care funding of €20 million nationally is being invested to support the recruitment of prioritised front-line primary care team posts and to enhance the capacity of the primary care sector. Considerable progress has been made in the delivery of primary care centres and 32 have opened since May 2011. Since 2012, primary care infrastructure has been approved and is under way at 15 locations through refurbishment, extension of suitable properties or through new build. Construction is under way at six locations and planning permission has been granted at an additional 22 locations under the operational lease mechanism.

The HSE is working with the National Development Finance Agency to progress the PCC public private partnership programme. Planning applications for the 16 PCC sites have been lodged recently or will be shortly.

Billy Kelleher (Cork North Central, Fianna Fail)
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My only fear is that the Minister of State actually believes what he read because if he does he is completely removed from what is happening in primary care. GP services throughout the country are under huge pressure. In supporting GPs there is an obligation to deliver on the primary care strategy, including the roll-out of chronic disease management and the other things the Minister of State mentioned. However, the Minister of State simply cannot read that answer into the record of the Dáil and think that everything is fine out there. He spoke about a phased roll-out. The critical issue is to have enough GPs to provide the service the Government will roll out in coming years. We simply do not have them at present. Every day GPs and their services are being downgraded. We need to underpin the longer term strategy by providing them with support. He has come in here and said we have planning permission for a few primary care centres when the core issue is supporting the personnel who will deliver primary care - GPs and the allied health care professionals who support them in the community.

Alex White (Dublin South, Labour)
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As so often, we come to the issue of credibility during oral questions on health. The Deputy's party, of course, did absolutely nothing on this agenda.

Billy Kelleher (Cork North Central, Fianna Fail)
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That is simply not the case.

Alex White (Dublin South, Labour)
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It published a document in 2001 or 2002.

Billy Kelleher (Cork North Central, Fianna Fail)
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In 2001.

Alex White (Dublin South, Labour)
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It then abandoned the health agenda completely and handed it over to Ms Mary Harney lock, stock and barrel.

Billy Kelleher (Cork North Central, Fianna Fail)
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We have handed it over to the Minister, Deputy Reilly, since then.

Alex White (Dublin South, Labour)
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We are now welcoming Deputy Kelleher back into the debate about the future of our health services. However, he makes no contribution other than to come in here and present himself as - it would appear - a representative of the GPs. I understood the GPs had a representative body, but Deputy Kelleher now seems to have appointed himself as their representative. Of course the GPs are important and are professional people, who are part of the service we want to provide and will provide in the future. However, there is a big job of work to be done in the reform of the health services, especially in primary care.

At least Deputy Caoimhghín Ó Caoláin of Sinn Féin has welcomed the development in respect of free GP care, but has asked quite rightly what the next steps will be. Deputy Kelleher is completely at sea and appears to have no policy whatever.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is a pity we did not get some answers. I remind the Minister of State that we are not in a courtroom but in the Dáil Chamber and my duty is to hold him to account.

Alex White (Dublin South, Labour)
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With some credibility.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am not here to advocate for GPs. However, the Minister of State might understand that GPs are the ones who see patients every week in their surgeries. However, they now cannot see them on the same day. In some cases referral times are down to two or three minutes. That is what is happening in surgeries and, as the person responsible, the Minister of State should know that, rather than coming in here and lecturing me. I am highlighting a simple fact. The Minister of State must understand that GP services are in crisis and GPs are crying out for help. I know the Minister of State is in discussions about a contract. However, in the meantime patients are suffering. The Minister of State talks about bringing more treatment of chronic illnesses into the primary care setting, but nothing is happening in that regard. We will end up with people being referred back to acute hospitals. I would like a few answers on the points I raised as opposed to lectures.

Alex White (Dublin South, Labour)
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An enormous amount is happening in primary care. A huge amount of change is happening and much more needs to happen. The doctors and other professionals who carry out a service are central to that. I do not know what the Deputy means by saying that referral times are down to two or three minutes - perhaps he means consultations.

Billy Kelleher (Cork North Central, Fianna Fail)
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I mean consultations. The Minister of State knows that is happening.

Alex White (Dublin South, Labour)
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He is suggesting that consultations may be as short as two or three minutes. In my job, I engage with doctors all the time, as does the Minister for Health. We are very well aware of what is happening on the ground in the services. It is simply not credible to suggest that we can address this enormous challenge for the health services overnight. We are introducing these changes and universal access to primary care is at the heart of it. I still do not know Deputy Kelleher's view of universal access to free GP services and whether he supports the proposal for free GP care for those aged under six.

Billy Kelleher (Cork North Central, Fianna Fail)
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I will tell the Minister of State if I get the opportunity.

Alex White (Dublin South, Labour)
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It is a vital element of what we need to do. I appeal to him because we will never change our health services by constantly politicising it in this Chamber. For this generation and the next generation we need a completely new health service. Throwing this kind of brickbat back and forth is not achieving anything.