Fidelma Healy Eames (Fine Gael) | Oireachtas source

I thank the Minister of State for his responses which have gone some way towards clarifying many issues that are being thrashed out. We have not yet been given full clarity, however.

I am a strong advocate of primary care, of which general practitioners form the backbone. The primary care system does not work without general practitioners. I built up a business case for a primary care centre in Oranmore for three years, during which time I was told one could have all the public health services and speech therapists in the world but it would not be of any use without buy-in from general practitioners. I want general practitioners to be on our side.

The Minister of State referred to theory versus practice. While I am fully in favour of the proposed measures in theory, how will they work in practice unless we have a sufficient number of general practitioners to deliver them? Does the Minister of State have a deadline by which he will make a decision on the contract? Is there a minimum number of general practitioners required to commence the roll-out and, if so, what is it?

It is great to hear that matters have moved on but I do not want an apartheid style system to emerge in the area of GP care for children aged under six years. Such a system was evident in BreastCheck for some time. I want universality and uniformity of service. The number of general practitioners needed to achieve this matters because if a child of under six years must wait seven days to interact with a GP for seven minutes, it will not be a proper service. Does the Minister of State agree?

I fully concur with the Minister of State on health promotion and prevention. I also agree that people will not make an appointment with a doctor to find out if they or their children could be candidates for diabetes if they must pay €50 to do so. However, there are other ways of rolling out these types of services. For example, we have rolled out screening programmes and developmental, sight and hearing tests in schools for many years. Having worked in the area of health promotion, I agree with the Minister of State that we must prioritise health prevention and promotion. To return to the basic point, how many general practitioners must sign up to the contract if a universal service is to be provided?

While I am pleased the Minister of State is willing to speak about the gagging clause, I share Senator Crown's view. Why would one want to hamstring a general practitioner who is acting for the good of a patient? The Minister of State is right to address this issue. He is also correct that it is not appropriate to manage negotiations on the contract from the Oireachtas. However, our job is to remove the unsavoury principles that underpin the negotiations and will prevent a deal being reached. I refer, for example, to the gagging clause and the provision prohibiting the sharing of medical records. Did the Minister of State indicate that the medical record will be sacrosanct between patient and doctor?

The Minister of State also indicated that a change in competition law will make it easier to negotiate with general practitioners. We must have clarity on whether that is the case. We require accurate facts and figures on the numbers of general practitioners who are willing to sign up to this contract. Otherwise we will have a theoretical framework that will never work in practice.

Amendment No. 10 refers to the modernisation of diagnostic services.