Billy Kelleher (Cork North Central, Fianna Fail)

I welcome the publication of the legislation to deal with the GMS and to lift restrictions on GPs accessing the scheme. The Minister's speech was fine until the end, but I will refer to the comments about quick fix solutions later.

The Minister makes the valid point that the health service must be seen as a single system in which all parts must work in unison and where there is a streamlining of resources to ensure best patient safety and outcomes from treatments. The GP is an integral part of that front line service. There is now a stronger emphasis on creating primary centres and on them being the front line in the delivery of health services in this country. I welcome that. It is something all sides of the House have supported over the years. To implement it obviously entailed huge challenges. There were difficulties with securing the buy-in of medical professionals, locating premises and with the roll out of primary care centres throughout the country. It is a work in progress, and many of these things took more time than originally anticipated or envisaged due to certain blockages, even in the context of planning issues in certain local authority areas.

In general, anything that not just fosters competition but makes the health services more efficient, effective and responsive to the needs of people and our communities is very welcome. This Bill is welcome legislation. As the Minister said, it is in the programme for Government, so he must be complimented on that. Of course, it is also in the IMF programme, which was probably a stick as well as a carrot for delivering it. However, I welcome the fact that it is here. There are concerns on the part of some GPs who might feel their businesses could be diminished. The health services, however, are first and foremost for patients and we should work from that premise back, rather than the other way around, as was the case for many years. That is welcome.

I have a few queries about the Bill. They are not criticisms so the Minister should not take them in that way. Sometimes we can be accused of criticism when we are being constructive. We will deal with section 6 on Committee Stage but has any analysis been carried out over a number of years to ascertain if there has been a move on the part of GPs from areas with socio-economic challenges and from rural areas? There is nothing in the legislation to provide that if doctors access a certain number of GMS patients, there is an obligation on them to ensure there are a certain number of surgery hours available in a particular place as well as an out-of-hours service. In Dublin, for example, there are still difficulties with the provision of out-of-hours services.

There are some very successful co-operatives across the country and they have been embraced by the people. Once that system is set up it works very well. SouthDoc in Cork, for example, is a model of the co-operative system, with doctors coming together to provide an out-of-hours service. There is no criticism in Cork of the SouthDoc out-of-hours service. Could this legislation undermine that co-operative element? Has there been any such analysis? I am not saying it will, but has there been an analysis of whether there might be a drift from socio-economically challenged areas and rural areas in that context?

On the broader issue, there is still a difficulty with the number of doctors coming through education, training and qualification. As the Minister correctly pointed out, a large number of our non-consultant doctors and GPs are heading abroad as well. That is a huge loss of talent, expertise and investment. We saw the difficulties this year in recruiting non-consultant hospital doctors. We were obliged to bring people in from abroad. They were welcome but at the same time some of our doctors were going abroad, reluctantly rather than in the interest of furthering their careers and broadening their horizons in terms of training and access to other ideas and innovations.

There is also the issue of the restrictive nature of the training of doctors. Obviously, it is critical that one has the best training and educational facilities, standards and attainment but as we roll out primary care and it becomes the front line, the number of GPs available to provide that front line service must be examined. Somebody said a few days ago that there are twice as many solicitors as GPs in this country, so perhaps we are out of step. I am not criticising solicitors but, all things being equal,-----

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