Tim O'Malley (Limerick East, Progressive Democrats)

I would like to deal with a number of issues raised in the motion before the House.

The development of primary care services is an essential component of the health service reform process. In a developed primary care system, 90% to 95% of people's day-to-day health and social care needs can be met in the primary care setting. The emphasis is on keeping people well and supporting them so they can live in the community rather than in institutional care.

The key objective is to give people direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists, speech and language therapists, home helps and others. These teams will be able to provide people with integrated, comprehensive services to meet their health and social care needs in the communities where they live. This has been characterised as providing the right care, in the right place, at the right time.

Funding totalling €32 million has been provided in 2006 and 2007 for the establishment of 200 primary care teams involving 600 new frontline professionals. Approximately 450 general practitioners are currently involved in teams, with a further 700 projected to join teams in 2007.

In November 2004, as part of the health Estimate the Government set a number of priorities including the provision of an additional 30,000 medical cards and the introduction of a new benefit, the GP visit card which would be available for up to a further 200,000 people. The Government provided the HSE with an additional €60 million for these measures. Last month 1.221 million people held a medical card, almost 77,000 more people than two years ago. On 25 January, almost 58,000 people held GP visit cards. Since their introduction, an average of 4,000 people have received a GP visit card each month. Approximately 30% of the population now has free access to the services of a GP under the general medical services scheme.

The Minister for Health and Children introduced the GP visit card as an innovative measure to provide a graduated benefit so that people on moderate incomes, and especially parents with young children who do not qualify for a medical card, would not be deterred from visiting their GP on cost grounds.

Significant changes have been made to the way in which people's eligibility is assessed. Those measures now mean that income is assessed after income tax and PRSI. The income guidelines, including allowances made for children, were increased by a cumulative 29% in 2005. In addition, allowance is now made for reasonable expenses incurred in respect of mortgage or rent, child care and cost of travelling to work. In June 2006, the Minister agreed to a further adjustment in the assessment guidelines for GP visit cards. They are now 50% higher than those in respect of ordinary medical cards.

With the increased number of people in employment, the continuing bright economic situation nationally, and people on higher wages, a greater proportion of the population can access services using their own means.

In making policy changes, the Minister sought to address the needs of people on low and moderate incomes by ensuring that they were not deterred on cost grounds from accessing GP services.

Between 2000 and 2006, approximately €139 million was allocated to the HSE to develop out-of-hours GP co-operatives. Those figures do not include the fees of participating doctors. In 2007, the Government provided a further €3 million to meet the full-year cost of co-operative developments commenced in 2006. GP co-operative services are now available in all HSE areas, providing part or full coverage in all counties. In late November 2006, the north Dublin GP out-of-hours service commenced providing services to a population of approximately 500,000 people. As with other GP out-of-hours co-operative services, patients can contact the service using a lo-call telephone number to receive medical advice and, as required, be seen at a treatment centre or at home by a GP.

The Government accepts that we must ensure that sufficient general practitioners are trained to meet the future needs of the population. Agreement has been reached with the Irish College of General Practitioners, ICGP, and the HSE on an increase of 66 GP vocational trainee places, on a phased basis. To date the Government has funded 44 such places in line with that phasing.

I now come to the vexed topic of postponed operations. The public acute hospital system admits over 1 million patients overnight or as day cases annually. The number of operations postponed represents a small percentage of the overall activity of acute hospitals.

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