James Reilly (Dublin North, Fine Gael)

It is Second Stage of the Health (Provision of General Practitioner Services) Bill 2011. It means that if suitably qualified general practitioners decide to set up practice not alone will they be able to treat private patients from day one, but also they will be able to treat patients holding both GP visit cards and full medical cards. There will be no limit on the number of contractors.

The new changes are being introduced on foot of the commitment in the EU-IMF programme which required the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors, including eliminating restrictions on GPs wishing to treat public patients. This was part of pre-election pledges made which are now being rightly honoured because as I pointed out the restrictions have had a detrimental effect in the past regarding the ability of younger, properly qualified GPs to set up in practice and deliver care and service to their community. In many instances in the past it was the difference between GPs deciding to stay in this country or to emigrate, and that has been to our loss also.

The current position is that GPs can only obtain GMS contracts in restricted circumstances where a vacancy arises due to the retirement, resignation or death of an existing GMS doctor; where a new GMS panel is created in response to an identified need for an additional doctor in an area; and where a GMS doctor obtains approval from the Health Service Executive, HSE, for the creation of an assistant with a view to partnership within his or her practice.

The HSE is currently required, before filling a vacant GMS panel or creating a new panel, to take account of the potential viability of the panel being established and the viability of existing GP practices in that area. The arrangements I have described prevented many young, highly qualified and trained GPs from obtaining a GMS contract early in their careers. The current system allows them to treat private patients but they are not able to treat medical card or GP visit card patients until such time as they obtain a contract from the HSE. They may have to wait several years for such an opportunity to present itself. That meant in practice, particularly in the recent economic climate, that GPs who were restricted to private practice could no longer look after patients and their families when they fell on bad times through no fault of their own due to the economic changes we have experienced and the downturn in which this country finds itself. Consequently, they had to find a new doctor when often they had no wish to do so because they had a relationship with their existing doctor. They also had to undergo a re-examination and a further full divulgence of their history, which can be particularly traumatic for people who have psychiatric or psychological problems. It is difficult to start one's story all over again with a new doctor when one's own doctor understands one's situation, knows one's history and with whom one feels comfortable.

In addition to the above, two other categories of GPs have certain restrictions placed on their rights to take on and-or retain GMS patients under the current arrangements. These are GPs who hold a GMS contract on foot of interim entry provisions put in place in 2009 where they would have to wait until 2013 before they could treat any medical card or GP visit card patient; and certain GPs involved in a partnership which is being dissolved or terminated before a specified period would not be allowed to retain the patients on their GMS list at the time of dissolution of the partnership. The Bill will remove these restrictions.

When this Bill is enacted, new GMS contract holders will be free to establish their practice in the location of their choice. However, a contract holder approved by the HSE in an area who wishes to move location may only do so with the prior approval of the HSE. This is designed to ensure continuity of care for patients and ongoing convenience from a patient's perspective.

I will outline some of the provisions of the Bill and the sections therein. Section 1 provides for the definition of certain terms used in the Bill. Section 2 provides that the HSE will be entitled to enter into a GMS contract with any suitably qualified and vocationally trained GP and it will not be limited to granting contracts where a GMS contract holder dies, retires or resigns from the GMS. I emphasise that GPs will have to be suitably qualified. There is no question of this being a back door for any inferiorly trained GP. Equally, I would point out that many of our young GPs in practice in private medicine are as qualified as their peers in the GMS but we must put in place controls to ensure that the people have the required training and qualification or equivalent training as recognised by the Medical Council and the Irish College of General Practitioners.

Section 3 provides that GPs holding a GMS contract will be entitled to accept onto their list any patient nominating them as their doctor of choice, subject to existing rules relating to panel size. These rules stipulate that the total number of GMS patients which may be placed on a GP's list shall not exceed 2,000 save where the HSE or such organisation as follows it, in exceptional circumstances, decides to apply a higher limit. This will ensure that GPs who hold a GMS contract on foot of interim entry provisions put in place in 2009 will, from the date this Bill is enacted, be able to take any medical card or GP visit card patient onto their list and they will not have to wait for two more years before doing so.

I would point out that the choice of doctor scheme has been one of the great successes since the 1970s and we want to increase that choice to the patient. It has empowered patients in more recent decades in that they do not feel they have to stay with a single GP as they did in the old dispensary system. It also creates competition among GPs to be more cost effective and to deliver the range of services people want in a modern society, and the more doctors we have the better from that point of view.

Section 4provides that when a partnership dissolves, a GP who wishes to continue participating in the GMS scheme may retain the patients on his or her GMS list on the date the partnership dissolves or terminates, unless the HSE is advised that any such patient does not want to remain on that list.Section5 provides that the HSE, when filling or creating a GP position, will not take account of the short-term or long-term economic viability of that or other GP practices. This will address a recommendation in the Competition Authority's July 2010 report on general medical practitioners, which was aimed at increasing competition within the GMS scheme.

Section 6 provides that where a GP has been approved by the HSE to provide GMS services at a particular premises, he or she cannot provide such services at another premises, unless he or she has submitted a request to the HSE and the HSE has given its consent. Therefore, a contract holder who wants to change his or her centre of practice can only do so with the prior approval of the HSE. Section 7 provides that when this Bill is enacted, nothing in the Act will affect the operation of the GMS scheme, other than the provisions set out in sections 2 to 6 of the Act. Section 8 provides for the Short Title and commencement of the Act.

In conclusion, the programme for Government provides for significant strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. This commitment will be achieved on a phased basis to allow for the recruitment of additional doctors, nurses and other primary care professionals. I and Deputy Róisín Shortall, the Minister of State with responsibility for primary care and the first such Minister in the history of the State, will oversee the implementation of this programme with the assistance of a project team of officials from the Department and the HSE.

I am confident this legislation will contribute to this commitment as it will encourage more young GPs to remain in Ireland and to establish their practices here, and it will make it more attractive for GPs to move here from overseas. It will also encourage competition among GPs at a time when many fee paying patients have less money at their disposal. Furthermore, it will answer our manpower problems. This legislation in conjunction with the plans for a new GP contract will address many of the issues that afflict our health service.

The health service operates as a whole and no single part of it operates in isolation. Consequently, if there are not enough GPs, the pressure is felt in emergency departments. If there is pressure on those departments, it is felt in the hospitals, and if there is pressure in the hospitals it will be felt in long-term care. No single part of the system acts alone, so the entire system must be addressed. We must address the deficits in primary care, in terms of manpower, the type of work it does and how it works. We must address the situation in the hospitals and how our consultants, non-consultant hospital doctors, NCHDs, nurses and ancillary staff work. We must also address the issues of home care, long-term institutional care and other models of care that are interim in nature and can be very successful in addressing the needs of our citizens.

That is the reason this Government has taken its own approach and made it clear that it might take longer than one term of office to bed the system in. I believe that shows a political maturity that has not been to the fore until now.

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