Brendan Ryan (Dublin North, Labour)

I welcome the Minister of State, Deputy Shortall, and I welcome the opportunity to speak on the Bill. Although a relatively short Bill, its provisions have the potential to deliver tangible improvements to GP services. It provides for both the elimination of restrictions on GPs wishing to treat patients under the GMS and allows patients the freedom to choose their own doctor without being tied to their GMS contracted practitioner.

At the most basic level, I welcome the fact the Bill provides the right for any suitably qualified and vocationally trained GP to set up a practice in the location of his or her choosing. For too long, the GP industry has been a closed shop or sheltered profession, providing unnecessary barriers to entry for young, aspiring GPs and, more importantly, creating conditions which have allowed for the escalation of GP fees for the ordinary Irish family.

The archaic restrictions referred to in the Bill created a form of elitism. We are witness to this in other sheltered professions in Ireland such as pharmacy and especially law, which retains the totally out-dated and exclusionary practice of "devilling". These professions also need to be tackled in the same way that the Government is tackling general practitioners in this Bill.

The GMS is currently availed of by 80% of GPs, who are cumulatively receiving upwards of €500 million of State funds to treat medical card patients. Examples of the individual amounts some GPs are receiving are quite staggering. In 2009 one GP in Dublin received €767,000 for seeing medical card and GP card patients, in Donegal a doctor received €754,000 and so on. In all, 58 GP clinics received over €500,000 in 2009, 156 received €400,000 to €500,000, while over 1,000 GP clinics received between €200,000 and €400,000.

These figures highlight to all of us the benefits to some of the barriers to entry for others. It also places the 20% of GPs not included in the GMS at a competitive disadvantage. GPs in this category are unable to avail of guaranteed State income and in many cases end up losing patients who qualify for a medical card and have to change to a GMS covered practice. With this Bill, patients will have the freedom to choose their GPs and will not be tied to one practice. This should also serve to end instances of opportunistic charging of medical card holders for tertiary services such as routine phlebotomy services.

The removal of limits in the number of contractors contained within the Bill will allow new GPs to set up business in areas where, up to now, one GP or practice has held a monopoly over a particular town or region. As with all monopolies, the customer, or in this case the ordinary Irish patient, suffers. Without competition, GPs can and do set excessively high prices to non-medical card holders. These people, usually low to middle income earners, many with families, can face high GP costs should they or a member of their family become ill. The standard price in my constituency of Dublin North is approximately €50 but there are practices charging higher prices for what can turn out to be a ten-minute consultation. Of course, there can be follow-on costs for prescribed medicines which further add to the cost of health care for the ordinary person.

All TDs in this House know of people in their constituencies who just cannot afford to go to their GP. If they do go to their GP, their shopping bill, electricity bill or heating bill will have to be put off, with serious consequences. This is the reality of the situation in Ireland today, and our task in this House is to introduce legislation which will ease the hardships being faced by ordinary people. In this Bill, we have an opportunity to improve services and decrease costs for ordinary people.

The Competition Authority in its report in July 2010 highlighted the fact that competition between GP practices and access to GP services will lead to greater access to GP services and better choice and quality of service for all patients.

I refer to general medicine's sister field of dentistry. Recent legislation obliging all dentists in Ireland to display prices publicly for all services they deliver, combined with other factors, has led to a more competitive market with some dental practices reducing consultation fees from €60 to between €30 and €40. Over the past three years, almost every person in this country lucky enough to retain a job has faced a wage reduction. This has impacted on people's standards of living but while they took wage reductions, there was no perceptible decrease in GP fees. By opening the market for GPs, increased competition from fully qualified practitioners should lead to reductions in prices for patients.

While the ultimate goal of this Government is to provide universal health care, the reality is this will take a few years to implement. In the meantime, I welcome the potential in this Bill for a reduction in the cost of health care. Health provisions are dealt with in the section entitled "Fairness" in the programme for Government. I believe this Bill will help rebalance what has up until now been an unfair system and I warmly welcome it.

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