Paudie Coffey (Waterford, Fine Gael)

I, too welcome the Northern Ireland delegation. I had the pleasure of visiting Northern Ireland recently to see my in-laws. I had the not so nice pleasure of having to visit a general practitioner there with my child, but an excellent general practitioner service is offered in Northern Ireland and free of charge. I am thankful for that and the delegates may carry that message home.

I welcome this opportunity to contribute to the debate. We need to acknowledge the importance of general practice historically. General practitioners in every village and parish have been known to almost every individual in their localities. I always considered general practitioners as having a vocation. The same applies to the public health nurses who have operated in the country over many years and kept health services running in the communities.

Previous speakers are correct in saying the service has changed significantly over recent years. It will change quite a lot more. There is a fundamental shift in how we deliver general practitioner care and primary care. This Bill will reflect that.

I acknowledge the role of the various general practitioners' co-operatives. Caredoc operates in my area. In fairness to the co-operatives, they operate very successful after-hours services.

Deputy Luke Flanagan should note there was concern at the outset that there would not be a service at the level to which he referred and to which we have been used heretofore. The service has responded well, however, and I do not hear as many complaints as I would have done some years ago. The service is up and running and accountable, and this is reflected in the level of service provided.

It is the intention of the Government, as indicated by various speakers, the Minister of State, the HSE and the Department of Health, to prioritise the delivery of primary care. The intention is to have patients cared for in their homes and communities in so far as this is possible and to remove the burden on the acute hospitals. This cannot occur unless there is a fully resourced primary care health system. The availability and accessibility of general practice health care, health nurse care and all the ancillary services and supports are doubtlessly essential to the model. This Bill is not only about reducing cost and increasing accessibility to health care services in the communities. We need to be very careful about ensuring the existence of a carefully managed, cost-effective and good service when the model is fully delivered.

I share the concerns outlined by Deputy Twomey regarding disadvantaged and rural areas. There was a period in my area during which a practice could not fill a general practitioner vacancy but, thankfully, it has now been filled. It is not easy to attract newly qualified GPs to set up practice in areas that may not be as economically advantageous as other areas. That aspect needs to be provided for in any new models to be rolled out. Incentives are required to encourage young qualified GPs to set up practice in these areas.

This Bill will fundamentally change the structure of how we deliver primary care and it will encourage young GPs to remain here and establish practices here. For that reason, I welcome the Bill. It will remove restrictions to access to the general medical service list. It will allow young GPs, with the approval of the HSE, to competitively tender for those lists but they will have to prove not only their qualifications but that they can deliver a GP service and support services.

I acknowledge that good progress has been made in the delivery of primary care health centres but there is still a good deal of work to be done in this area. The Minister is working hard with the Department to ensure that they are rolled out as quickly as possible.

The role of the practice nurse was mentioned. That role is an enhanced one and it should not be under-estimated. Practice nurses now support GPs and these nurses have full professional qualifications in treating diabetes, obesity and heart disease, three of the biggest health care challenges facing the people of this country. It is important to utilise the resource of a practice health nurse working with a GP and other practitioners such as physiotherapists, chiropractors and psychologists. I have noticed that consultants are also operating out of some primary health care centres. That is a good move. I have noticed in my constituency of Waterford that some consultants travel from Dublin to run a clinic one day a week. This means people can have access to that next level of service in primary health care centres and do not have to travel outside their communities. That is important and should be encouraged.

I refer to the provision of step-down bed facilities in communities. HIQA has an important role to play in maintaining standards in community hospitals but we need to review legislation in that residential homes for the elderly are clearly not nursing homes. There are a number of such residential homes in my area in south Kilkenny and Waterford, which have provided good step-down facilities for the elderly for many years. Elderly people in the whole of their health are cared for in such secure residential homes. Such homes have to meet the same standards as nursing homes and that is creating a problem for residential homes. Some of them may not be able to remain open as a result of that.

St. Patrick's Hospital in Waterford is a hospital for the elderly with full geriatric services. There was a commitment in the Health Service Executive plan for 2009 for the provision of a new 50-bed unit for that hospital but unfortunately that is no longer the case. I would like to see that reinstated. The service provided by hospitals such as this one removes a burden from the acute hospitals. Such services enable people to move to a step-down facility from which they can subsequently return to their communities and take full advantage of a good GP service with the full role out of community services to support them. This Bill is a step forward but we need to proceed with caution.

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