Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Very significantly the report opposes the corporatisation of the development of the new primary care infrastructure. The danger of corporatisation is one of the concerns raised by some medical professionals in the context of this Bill. If the Minister is following the exchanges on the proposed legislation in the various medical journals, he will be familiar with what GPs and others are saying. Writing in the Medical Independent on 8 September, Dr. Raymond Walley, a Dublin GP, expressed the view that as big companies in the health care area are specialists at tendering, such corporations will win GMS contracts, allowing them to utilise GPs as employees.

The report of the Joint Committee on Health and Children, which I have just cited, was very clear on this. It states the following in its recommendation No. 14:

The committee strongly opposes the "corporatisation" of the development of new primary care infrastructure. It recommends that a system of incentives be provided that would result in: the development of primary care centres by professional members of the primary care teams who will be directly involved in each centre and; the exclusion of large-scale corporate interests from such incentives.

I am of one mind with that view.

The Government has promised free GP care for all within its term of office. That is a very big commitment. It is one my party and I fully support and have long advocated. However, there is very little sign that the Government has even begun to put in place all that will be required to deliver on it.

The Minister of State with responsibility for primary care, Deputy Róisín Shortall, admitted earlier this month that the Government does not yet know how many additional GPs will be required for the new free GP care system. That is crucial information. She said the study of the additional number of doctors needed would be completed by the end of this year. Perhaps she, or the Minister in his closing remarks, can confirm this and give us an approximate date for when the report will be published.

The Government needs to recognise that a comprehensive study is also needed to identify where, as well as how many, GPs are needed. Where is just as important as when. Indeed, such a study is essential. The Minister of State acknowledged that there are what she called blackspots where there is a shortage of GPs. I have just cited some examples of these blackspots. These need to be clearly identified throughout the jurisdiction. Measures need to be put in place to remove those gaps. We need good planning and good implementation of an effective primary care strategy to ensure that all communities are served equally and that every citizen has access on the basis of need and within easy reach of where they live.

The Bill addresses only one aspect of the problem of primary care delivery. As another GP stated in that Medical Independent debate which I cited:

The system is flawed in so many ways that my fear is that resolving the GMS access mechanisms may lead those in positions of power to say "Phew! That's the GMS system sorted", when in reality it is just the tip of the iceberg.

No previous Government ever promised more on health care to the electorate than this Fine Gael-Labour Party coalition. Good for them. However, it is the delivery and the implementation that Opposition voices must watch and mark them on. In these times we understand the difficulties but we have yet to see the colour of their money. That is what it will come down to and so far the signs are not good. The cuts imposed by the Fianna Fáil Party and the Green Party are continuing and even worse is in prospect if we are to believe half of what might present in the 2012 budget on 6 December.

The Minister has contradicted his own words when in opposition regarding the dire impact of bed closures. Last night, I pointed out the relevant quotes and how his position has changed since he left this side of the House and took up his seat on the other side of the Chamber. There is no doubt that he is bringing private management into two of our largest hospitals. These are not small developments in Galway and Limerick. He cannot tell us when the promised White Paper on universal health insurance may be published, although it was supposed to be early in the lifetime of the Government. That is what we were given to believe.

I will not oppose the passage of the Second Stage of this Bill. I hope I will be able to support it on its way through the House. However, the GMS system needs to be opened up. While the Bill serves that purpose, it does not deal with all the issues. The Minister knows that. The points I am making are absolutely valid. I do not criticise for the sake of criticising.

I have noted the comments of others in this debate and in the various medical periodicals. A totally free market, laissez-faire approach to primary care or to any aspect of our health care system will only make matters worse. Therefore, I have reservations regarding the Bill and I will endeavour to address these on Committee Stage in the hope that it can be improved and strengthened. I would welcome the Minister giving consideration to the concerns I have expressed and those of others who are within the GP cohort serving our respective communities across the State and explore what can be done to strengthen the Bill as it makes its way through the Oireachtas.

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