Simon Harris (Wicklow, Fine Gael) | Oireachtas source

Let me state the obvious in relation to FEMPI. Of course it has had an impact on general practice, just like it has had an impact on so many contractors and public servants across the country. We all know the rationale and the reasoning behind its introduction. There was a national financial emergency. We know the economy is in a much better place now, thank God, and we know we are trying to move to higher ground in that regard. We are obviously engaged in contractual discussions with GPs. I have made it very clear - I will make it very clear again - that the totality of those discussions should not be seen to merely relate to the €25 million primary care fund in the budget. GPs have issues they want to discuss as part of the contract negotiations. I have issues that I want to discuss and that is the mechanism whereby we should discuss them. Let me be very clear though; the Government wishes to invest significantly in general practice on a multi-annual basis starting in 2018. There is an opportunity for GPs now to reach agreement with the State in that regard that will see more funding spent on general practice and more funding going into general practice, which will help address the issue of sustainability.

There would not be a need for negotiation in any situation if it was not the case that there are two sides often with different asks and different sets of priorities. There is a lot of overlap in some of the things GPs want to do if they are resourced and some of the things we want GPs to do and in primary care generally. There are also some issues on which we do not agree. That is the purpose of negotiation. I hope members hear me clearly this morning send out a message, as the Minister for Finance did in his budget day speech, that the Government is willing to look at this in a multi-annual sense. The Minister for Finance is willing to see significant additional resources in general practice, starting in 2018 and for every year after that. We have a busy agenda of things to discuss. I do not want to say any more than that publicly but that is quite a significant and important message to send to GPs, namely, that we are deadly serious about wanting to deliver a contract that works for them and wanting to see them adequately resourced to do their job in a sustainable fashion.

On the issue of GP recruitment in general, I see the Irish College of General Practitioners, ICGP, is now running a very vigorous and visible campaign in terms of recruitment in advance of the next intake of GP trainees. I have met the ICGP in that regard and I met with it at a careers day recently in Dublin Castle. I am very grateful for the ownership it is taking of the issue. The Irish College of GPs is speaking directly to GPs and GPs are encouraging new young medics to become GPs as that is quite impactful as well.

I agree with what Senator Swanick said about district hospitals and, more important, Sláintecare agrees with him as well. We need to find the right role for every part of our infrastructure across the health service and that includes a greater and enhanced role for district hospitals and doing what is appropriate to do in a district hospital. We agree with him on Belmullet. That sounds like it was a very difficult and challenging time for people there. I will ask the HSE to provide Senator Swanick with an update on plans for Belmullet. We will come back to him directly.

Deputy Durkan asked whether the budget will suffice. This is the age old question. I have a very clear view on this. One can have an old and fuel inefficient car and one can spend a lot of money on the car but the car is still old and fuel inefficient. It is the same with the health service. That is not in any way a disparaging comment; quite the contrary. It is a fact that we need to put in place a more efficient vehicle for the delivery of our health service. I heard the director general talk about that as well. It is not just a health service responsibility, politicians have a responsibility in that regard. Reform has been stop-start, confusing and at times incoherent. I assure Deputy Durkan that I see Sláintecare as the journey to getting that new vehicle. I really do. When we had the all-day Cabinet meeting in Cork last Friday we took a number of additional steps beyond the resourcing issues that took place on budget day in terms of the impact study Sláintecare asked me to do on public versus private, and appointing Donal de Buitléir to carry that out and report by next summer. That will include asking the public and those working in the health service how one aligns community healthcare organisations, CHOs, and hospital groups, because that needs to happen, and how to do it effectively, and also bring back a performance and accountability type structure in relation to a board for the HSE. I heard the director general talk about how the governance structures in the health service currently are not fit for purpose. They were only ever meant to be temporary or stop-gap structures. We cannot have a situation where we do not have a board to which the HSE is accountable. It is very important that we get the right skill set in relation to that. It will require primary legislation. It is a recommendation of Sláintecare. I hope with the agreement and co-operation of members that we could progress that very quickly through both Houses of the Oireachtas as well.

In response to Deputy Durkan, Ministers for Health long after me could sit here and talk about the health budget increasing, and that will result in benefits - I do not dismiss the need for resources. We need to see benefit in particular in areas like waiting lists. Huge resources will be spent in 2018. We have seen figures fall for two months in a row now and we need them to keep falling but increasing the budget is not going to be enough in and of itself, it must include the reform piece as well.

To address Deputy O'Connell's question on the HPV vaccine campaign, in recent days I asked the same question which she asked. I am told that it is too early to see the data. I do not know whether Mr. O'Brien has any data on it, but I have not seen any yet. There has certainly been a very effective campaign and I appreciate the support of everybody in this room in promoting that. I hope we will see a benefit from it but I have not seen the figures yet.

On primary care centres, the Deputy is right. We have invested a lot in the infrastructure, but if the lights are off at 5 p.m. people will still find themselves having to go to the acute hospital setting. Part of the discussions with the GPs - and I am not putting it all on their shoulders - is about how to keep these centres open longer, but there are also things we can do through the primary care fund such as community nursing, advanced nurse practitioners and helping with chronic disease management in the community. We can see progress on a number of those fronts as a result of the budget day announcement.