Barry Cowen (Laois-Offaly, Fianna Fail)

We, as a party, are very much in favour of opening up this sector and allowing more doctors to qualify for general medical service contracts. We accept this Bill in principle. However, there are some issues we would like to tease out and deal with in the Minister of State's response. I am very much in line with what Deputy Twomey said in his excellent contribution in this regard. This legislation could have a negative effect on primary care in certain areas. As Deputy Twomey said, it may result in the flight of doctors form rural and low income urban areas because they may not be seen to be profitable enough.

Does the Bill make provision for 24-hour GP access and what about a provision for capping costs? We would like to co-operate and try to improve the Bill, rather than its introduction being a missed opportunity. We recognise that in recent years there have been positive advancements in general practice, as has been said. Primary care centres are innovative and professional with various fields of expertise within them, meeting new demographics and freeing up hospitals for more severe cases, and that is to be welcomed.

Does the Bill adequately address the provision of out of hours services? We do not believe it does. In some areas doctors amalgamate to provide out of hours services. Will that practice and their position be compromised by virtue of these proposals?

With regard to qualifying doctors and the availability of doctors, how many do we retain within our system and how many move abroad? What research and analysis on the training needs and requirements has been carried out? Have those who have qualified been surveyed and analysed as to their response to what they find upon qualifying?

On the area of home care or step-down facilities to relieve our hospitals, can some mechanism be devised at this stage to improve the role primary care facilities can have in this regard? Can health care and the promotion of healthy lifestyles be introduced to school curricula? Is consultation taking place with the Minister of State's counterparts in the Department of Education and Skills to promote this idea? What role can these primary health centres have to engender the healthy lifestyle aspect of living.

We recognise that the key provision of the Bill is that the HSE will be entitled to enter into a GMS contract with any suitably qualified and professionally trained GP. We note there will be no limits on the number of contractors, which should reduce costs, and this is a fact that we welcome. The Bill will also result in some medical card and GP visit card patients having a greater choice of GPs under the GMS scheme. We acknowledge that 74% of GPs believe that access to GMS contracts should be open to all qualified GPs.

In regard to the free movement of GPs, new contractors will now be free to establish their practice in the location of their choice. A contract holder who wishes to move location may do so and I presume that would be with the approval of the HSE. The basis for such approval is not clear, nor is it clear how it will work.

Will this deregulation cause a shortage of GPs in rural or low income urban areas? Deregulation may lead to the State losing what control it may have over the distribution of doctors. The IMO president said the deregulation of the GMS will lead to difficulties in filling GP posts in rural regions and areas of urban deprivation. There could be a flight of doctors from low population rural areas and low income urban areas because they are not now seen to be profitable enough, which harks back to a point Deputy Twomey made. Doctors should not necessarily just be allowed to set up in affluent areas, rural areas must be adequately covered. I hope to hear from the Minister of State how that is to be done.

There are no caps on GP fees. Is this another missed opportunity or is their an avenue open to the Minister of State in the legislation to bring that about? How does the legislation lead towards free GP care, as promised by both parties prior to entering Government? In respect of some of the promises made, is there provision for them in the upcoming budget? What provisions are made in this respect in the programme for Government and what is the timeframe for those to be brought forward?

Universal primary care insurance was to be extended on a phased basis to the proportion of the population who do not have a medical card so that by 2014 it was envisaged that every person registered with a GP would be insured for primary care. This means patients will no longer pay up-front fees when they visit their GP. This was to begin in the first year of Government and I presume this legislation will provide for that. This is to be done by extending primary care insurance for GP visits to people on the long-term illness scheme. It is to be paid for out of existing Exchequer funding and savings provided for in the health budget going into a primary care insurance fund. Can the Minister confirm whether this is provided for in this fiscal year and, if not, will provision be made in the next fiscal year and will it be confirmed in the budget?

Fine Gael announced it would enter into discussions with insurers on how GP care could be extended to all clients at a reasonable cost. Have the parties in Government reached a compromise in this regard and how will that impact the legislation?

Fianna Fáil supports the Bill in principle, albeit with the reservations we have outlined, and we welcome the opportunity to debate it. I hope the Minister will be able to enlighten us on how he proposes to fill the gaps identified during the debate and how the commitment to providing free GP care for all will be funded.

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