Séamus Healy (Tipperary South, Workers and Unemployed Action Group)

With the agreement of the House I will share time with Deputy Finian McGrath.

I am glad to have an opportunity to speak on this Bill, which I welcome. It is hoped it will be helpful in the development of our primary and community care services. Everyone in this House is of the view that the development of primary and community care services is essential to the proper delivery of health care in this country. I support the development of services in the community to the largest extent possible, be it care of the elderly, mental health or general medical services. Community-based services are key to health service delivery in this country. This does not, however, mean we can dispense with hospital-based services. The driver of proper service delivery in this country is the development of community and primary care services.

While our health services have not been developed to the fullest extent possible, there has been much development in the community and primary care area. I compliment the voluntary organisations involved in care of the elderly. Services such as meals on wheels, day care centres, the Society of the St. Vincent de Paul and other church-based organisations, senior citizens organisations and sheltered housing ensure our elderly can continue to live in their homes and communities. While the services provided by these organisations are excellent, they need to be developed further.

The delivery of primary care centres and primary care teams is important. A previous speaker spoke about delivery through the various primary care centres of not only medical services, but ancillary services such nursing, OT and dietetic services and the development and provision in these centres of a holistic health service for people within the community. I agree with his remarks in regard to preventative health services in respect of obesity, smoking, lifestyle, diet and so on. There is no doubt but that community care is key in the delivery of health services. While there have been some good developments, more needs to be done. This Bill, while only a small part of that process, is a positive part of it.

We need to address the issue of location of general practitioners and to increase the average number of general practitioners per head of population here. As stated by Deputy Ó Caoláin, the average number of general practitioners per head of population in Ireland is 52 per 100,000. In France there are 164 per 100,000, in Austria there are 144 per 100,000 and in Germany there are 102 per 100,000. The figure of 52 per 100,000 for Ireland masks areas with substantially fewer people. It can be difficult to get GPs to locate on a permanent basis in rural areas. It is often difficult to get them to fill short-term vacancies in rural areas. Many large urban disadvantaged areas are not adequately covered to the extent they should be based on the average number of GPs per head of population. Perhaps the Minister will, when responding, reply to the following question. Can this Bill be used to direct GPs who come into the system under the General Medical Services scheme into rural and large urban disadvantaged areas, which are currently only served by a skeleton service?

I note that under this Bill new general practitioners will be initially allowed to choose their location but will not be able to change their location without approval from the HSE. Could a similar provision be included to provide that GPs could be directed or------

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