Oireachtas Joint and Select Committees

Wednesday, 13 May 2015

Committee on Health and Children: Select Sub-Committee on Health

Health (General Practitioner Service) Bill 2015: Committee Stage

5:10 pm

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I welcome the Minister of State with responsibility for health and primary care, Deputy Kathleen Lynch, who is an ex officiomember of the committee and thank her for attending. I also welcome Mr. Tom Monks, an official from the Department. This meeting has been convened to consider the Health (General Practitioner Service) Bill 2015. As this is a select sub-committee of Dáil Éireann, officials cannot participate and are only here to assist the Minister of State. There is no list of amendments to be circulated.

Sections 1 and 2 agreed to.

SECTION 3

Question proposed: "That section 3 stand part of the Bill."

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I wish to draw attention to section 3(13) which is one of the practical areas in terms of the provisions of the Bill. It states:

Insofar as considered practicable by the Health Service Executive, a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section.

Knowing as we do the great difficulty in realising the spirit of that particular subsection, can the Minister of State offer any further comment?

A number of people have drawn my attention to it, but I cannot see any logical way of amending it because it reflects a reality, a state of play that we will not be able to change in the progress of this legislation. For many people, there will not be a choice. Close access would be a luxury for many, particularly in rural Ireland but not confined thereto. This would also apply in some urban centres, especially in parts of Dublin. What are we doing to attract more trained doctors to take up positions in general practice? The Minister of State is more exposed to the facts across the State than I am, but I am surprised that, even in very large and generally attractive urban locations, there has been difficulty in attracting doctors to take up vacant positions in practices with GMS associations. I was very surprised that this was the case for some time in my home town. It made no sense to me, although the issue has now been addressed. I welcome this and wish the new holder good luck. What can we do to attract more doctors into general practice?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue which will become less of an issue in the future. The things we are doing for the over-70s and the under-sixes will provide reassurance for younger doctors and those in middle age who are prepared to come back from abroad. We can put other things in place such as the shared list. We have more women than men who qualify as GPs and the position is difficult because of family commitments and the choices people have to make. The ability to share a list will have a positive impact on our lack of ability to attract GPs.

Because of the circumstances in which the country found itself some of the financial incentives and grants available in remote rural settings were removed. We are looking at them again. I am not saying they will be returned in full or even as they were, but we have to look at how we incentivise people to serve more remote areas. It comes as a surprise to all of us that even with a good general list, even in an urban setting, although not necessarily the capital city, there is a reluctance to take up positions. That is easing and there is an assurance in the system for people coming back. The things we are doing for the over-70s and the under-sixes will attract people, but it is something we cannot take our eyes off. If we are serious about primary care services, we must ensure the gatekeepers within the system are available to deliver the service. It is something about which we are concerned.

Question put and agreed to.

SECTION 4

Question proposed: "That section 4 stand part of the Bill."

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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It would be remiss of me not to comment on the Bill, having made contributions on Second Stage. It states: "This Act will come into operation on such day or days as the Minister for Health may appoint by order or orders, either generally or with reference to any particular purpose or provision, and different days may be so appointed for different purposes or different provisions". About what provisions are we talking? Does this refer to assessing resources? We are talking about rolling out free GP care for the under-sixes and there are concerns about the capacity to absorb that number of children for the purposes of providing free care at the point of service. It is a welcome provision, but it raises the question of whether, at the other end of the spectrum, the over-70s will require more frequent visits to GPs as they suffer from more chronic illnesses. Will GP services have the capacity to deal with more complex cases within primary care, in view of the fact that the stated aim of the Government is for the primary care system to be the bulwark in the delivery of health care? We are trying to decrease the numbers going into the acute hospital sector and I assume this is to provide an incentive to do so. Is the fact that the section allows for the legislation to come into force when the Minister so decides designed to take account of the requirement to increase capacity within GP services?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The Deputy is right. As we age, we develop more chronic conditions. In the context of the over-70s legislation, people suffering from chronic conditions are living a lot longer. As some of the over-70s already have GP cards, there will only be an additional 36,000 GP cards, whereas there will be 240,000 under-sixes in the system. The total number is not so great, but I agree with the Deputy nevertheless. Many of those with chronic diseases are probably already being managed by their GPs and, while any health service must have an eye on resources, the numbers involved should not cause problems for GPs.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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As we are about to reach the end of our consideration of this Stage of the Bill, it would be remiss of me not to ask if the Minister of State has an update on the provision of universal access to free GP care. This is one part of a two part process involving the under-sixes and the over-70s and there has been recent commentary on further age-related roll-outs. I remember addressing this matter with the then Minister of State, Deputy Alex White, at the time it was first mooted when I told him I would support the measure as long as there would be a short journey until full roll-out. Is the Minister of State in a position to update us before we conclude this Stage of the Bill?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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We would all have preferred it to have taken less time than it has and we are still not at the end of the process. GPs have until the end of May to decide and even at that point I would not be inclined to bring down the shutters. Given that it is a significant change to the way GPs deliver the service, it is important that we allow a reasonable, albeit not unlimited, time for them to sign up.

Sometimes politicians are too anxious to achieve something, but we are stopped in our tracks by a process in a different area. The intention is that the under-sixes will be covered by the end of June, if we manage to contain the timeframe we have set out. We have begun the process of negotiating the bigger contract with GPs which has been in place since the early 1970s and which needs to be updated, given that medical and primary care services have changed so significantly. As part of the process, we intend to roll out the service to all children in primary education, to approximately the age of 12 years, and then to children up to the age of 18.

I doubt that there will be any disagreement, although there might. The Deputy and I will agree that we are lagging way behind the rest of Europe in the delivery of primary care services and keeping people well and out of acute hospitals. This is the beginning and if we manage to implement the new system as smoothly as can be expected, although it has not been smooth up to this point, the rest of the process will happen more smoothly and within a shorter timeframe. I agree with the Deputy that it cannot go on forever.

Question put and agreed to.

Title agreed to.

Bill reported without amendment.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I thank the Minister of State, Deputy Kathleen Lynch, Mr. Thomas Monks and Deputies Robert Dowds, Billy Kelleher and Caoimhghín Ó Caoláin for their presence.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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We deeply appreciate the fact that the committee made itself available at the end of a very long day to conclude Committee Stage of the legislation. This shows our collective commitment to ensuring people in certain categories will have access to GP care, provided they meet the criteria laid down.