Mattie McGrath (Tipperary South, Independent)

I welcome this Bill and compliment the Minister and all concerned for introducing it. I look forward to its passage and enactment; it is long overdue. I cannot understand why it took the troika to add haste to the situation. No matter the reason, I am glad it happened. There is a great deal of anti-competitive practices. I compliment the vast majority of GPs and their staff, who work hard and give a good service in a difficult job. Many have given long years of good service to the community. A situation, however, has evolved where change is badly needed.

Entry to the GMS scheme is an issue. In 1970 medical cards were made available to people who in the opinion of the health service were unable without undue hardship to arrange general practitioner services for themselves and their dependents. These were followed by doctor only medical cards. The 1989 agreement is outdated and it is time to change it. Previously, vacancies were not available until someone retired or died. Older people might enjoy a long relationship with their doctors but times have changed and medical practice has advanced. It is a pity to see young GPs, who have made a huge investment over the years in their education, emigrating, as is happening in so many sectors, when they are needed at home. They often made considerable sacrifices to attain their qualifications. It is a shame there is not more competition so there would be more areas for them to move into.

The Competition Authority made recommendations in this area, although in many other areas it did nothing, and these were taken into account in this Bill. The statistics are frightening. There are almost 2 million medical card holders and 129,000 GP visit card holders. Expenditure amounts to €435 million. There are 2,600 GPs in active practice, with 2,279 holding a GMS contract. An additional 300 doctors work in a locum capacity. Those are phenomenal numbers providing a service to people who need it.

Some consultants use hospital services to treat private and public patients but GPs must have their own surgeries and equipment. Investment is huge so we must not throw the baby out with the bath water. There should be a cap on the remuneration that can be earned from the GMS scheme. While we are trying to introduce a maximum wage and to be fair and balanced, they are self-employed and must pay insurance and provide facilities but there must be a way to avoid the fatigue that results from having too many patients.

It is a pity we had to wait for the IMF to come in to make these changes but I welcome them anyway. Dentists were mentioned and I remember the protests when they were made to display their prices. It has worked for the benefit of the consumer and I see no one complaining about getting less of a service. A visit to the dentist is unnerving but no one is saying they are any worse off. In fact, prices have come down because the displays mean people can shop around. This legislation could include such a provision for GPs to be required to clearly display prices of all services. I have a large family and barely a week goes by without having to visit the doctor but sometimes we might only see a nurse. There is a range of services and the charges for them should be clearly displayed. If blood is being taken, a person should know how much he is being charged.

A person should also have the right to change GP, as I have because I do not have a medical card. My GP provides a good service and is located in a large practice with a number of GPs. I have an issue, however, with the availability of doctors at night, something the Bill fails to address. It is a sad state of affairs that in 2011, if a person has a sick animal, a vet can be called at 3 o'clock in the morning and he will be there in a half hour but the same person cannot get a doctor. Caredoc operates in my region, and I welcome the fact that fears that some of its services were being cut back have been allayed, but no mother wants to bring a child to the doctor unless she needs to and it is desperate when she cannot get a GP home visit. Even in the practice I attend it is so busy that if we want a home visit, we must wait until 7 p.m. or 8 p.m. They are reluctant to do it. It is terrible that a pet can get treatment quicker than the owner; that is morally wrong. GPs have earned their time off but there are huge issues in the Caredoc system. It is a fire brigade service and it is not good enough that if a person wants a GP, he cannot get him. He must ring this service, tell the person on the other end of the line what is wrong and that person will ring back. That is not good enough. Someone who is panicking or lying out cold on the floor cannot relay that information. It is not fair for those elderly people who have given some service to the State and paid their taxes. They deserve better.

I referred earlier to consultation charges. Like most people, I am charged €50 for a visit to my doctor. Some individuals are charged €60. In the past two to three years, most fees have been reduced. The Government, like that which preceded it, is concerned with reducing the cost of living and prices. I had many discussions - some of which were quite animated - with the former Minister for Health and Children, Ms Mary Harney, in respect of this issue. Ms Harney always maintained that in certain European countries one will only be charged €10 or €15 for a visit to a GP. It is not acceptable that Irish GPs have not reduced their prices or have not been obliged to do so. The Competition Authority should be involved in this matter. Everyone has been obliged to accept cuts, large numbers of people have lost their jobs and many businesses are struggling to survive but GPs are still charging the same amounts they charged during the Celtic tiger years. That is not acceptable. GPs should be obliged to display their prices and they should be forced to reduce the cost of a visit to at least €40.

When medical card holders are obliged to seek additional services from their GPs - such as having driving licence application forms completed, blood tests, and so on - some are being charged an additional €10, €20, €25 or €30. That is not good enough. The people to whom I refer have medical cards because they do not have the money to pay for medical services. It is not acceptable that GPs should be paid through the GMS in respect of patient visits and then charge extra for additional services. The Competition Authority should address this matter also because the transactions involved are all done on a cash basis. I do not know if these transactions are recorded but what is happening is not acceptable. Many of my constituents are concerned with regard to this type of practice.

People have always respected and admired their doctors, which is only right and proper. However, this has led to a situation where individuals are afraid to challenge their doctors or discuss matters with them. Let us face it, one is generally in a fairly delicate situation when one visits the doctor. I have a fear of injections and that places me and others like me at somewhat of a disadvantage. Elderly patients who have built up relationships with their doctors over many years would not dream of questioning them and if they were asked to pay €100, they would hand it over. The Competition Authority should investigate what is happening. I am surprised that GPs have not been requested to display their price lists and those relating to chiropodists, nurses and others who might provide services on their premises. I accept that GPs provide their own facilities, but a cap must be introduced in respect of the fees they charge.

I am concerned with regard to the bureaucracy which attended the recruitment of non-consultant hospital doctors from abroad earlier in the year. The advertisement process relating to this matter was expensive and elaborate but it was also well done. The only difficulty is that some of those who were offered jobs here have still not entered employment. I do not know the exact figure but it is outrageous that some of these doctors are still not working in our hospitals. I do not know whether the HSE, the consultants or the Irish Medical Council caused this problem but what has happened is scandalous. The junior hospital doctors to whom I refer came to this country, in good faith, to work and now we are hearing all sorts of stories about some of them being placed in rented accommodation and not being allowed to work. Some bureaucratic barrier put in place by one or all three of the entities to which I refer stopped a number of these doctors entering employment. As a result, there has been increased pressure on consultants, beds and wards have been closed and hours of service have been reduced. The junior doctors to whom I refer have almost been the subject of house arrest since they came here. The situation in which they find themselves is degrading and steps should be taken to ensure that there will be no recurrence of what has happened.

I compliment the parties responsible for recruiting these doctors. They did a good job and those who were offered work in Ireland travelled here in good faith. What befell them could only happen in Ireland. Bureaucracy has reached a crazy level. Governments and Ministers come and go but officialdom is permanent and it is draining the lifeblood from this country. All those in officialdom are concerned about is protecting their own patch. These people are afflicted by greed. I am not in a position to point the finger at anyone in particular but the type of greed to which I refer must be rooted out. What happened in the case to which I refer was extremely distasteful. The junior doctors brought here from abroad are eminent and qualified. Everything was done above board in this instance and no shortcuts were taken. Had shortcuts bee taken, these individuals would never have been recruited or brought to this country.

What happened in this case sent a terrible message to the home countries of these junior doctors. In the past, Ireland has sent ambassadors abroad - both lay people and members of the clergy - and they did much work wherever they went. They and others, such as the NGOs, continue to work. However, their legacy is being tarnished by this shameful and outrageous episode. I hope the Minister for Health will be able to come to grips with the matter and that there will be no recurrence of the events we have witnessed. I do not envy him his task and I wish him well in respect of it. The mandarins who caused the problem must be rooted out because they are giving our country a bad name and delaying progress. In addition, their actions are having an effect on people's health.

I represent a rural constituency. I am aware of a case involving certain doctors who were providing services to a rural village and its hinterland and who decided to retire. Following their announcement, everyone in the area was involved in a great battle to retain the health centre and to have a new GP appointed. People in the community to which I refer were quite scared when they realised they could lose their local health service. I am aware of other instances where public meetings were held and lobbying took place in counties Waterford and Tipperary because people were frightened that they would not have access to local health services. It is not acceptable that people should be concerned in respect of issues relating to health. In the instance to which I refer, great efforts were made to oblige the HSE to appoint a new GP to the local health centre. The excuse put forward by the executive on many occasions was that it was not possible to employ a GP to take up the position. That may well have been the case but situations such as that to which I refer must be addressed.

The position is this regard is similar to that which exists in the context of rural transport. I am involved with the fledgling rural transport service in Tipperary - which is operated by volunteers - and it is not acceptable that people in rural areas do not have access to the same services as those in more built-up areas. Some of the medical practices-health centres in rural areas that have been closed were not exactly small operations. I do not know whether the HSE just wanted to close them down but whatever the position, a great deal of unnecessary worry and angst was visited upon families and others. Elderly people and mothers with children who did not have access to transport needed the security of having a doctor nearby. Their doctors might not be at the health centre every day but they were present on most occasions and had all patient records on file. This matter is not addressed in the Bill but it should be because continuity of service is required.

People need to know that if their doctor becomes ill or decides to retire, a locum or replacement will be put in place. Citizens must be able to visit a GP whose practice is situated within reasonable distance to their homes. Not everyone is in a position to travel to the nearest town. Many families never had second cars and with the advent of the recession, those who did no longer possess them. If one partner is working, it is often the case that the car will not be available to the other. As a result, people cannot travel far to visit their GPs. As already stated, unlike their colleagues in veterinary medicine, GPs no longer make house calls.

I welcome the many benefits to which the Bill will give rise. In the future, people with GP-only medical cards will have greater choice in respect of which GP they attend. It is important that people should have such a choice, particularly if they have difficulty with a certain individual, wish to change practices or want to seek a second opinion. People are entitled to a second opinion and to move to another practice if they so desire.

The Bill will ensure that any suitably qualified doctor who wishes to obtain a GMS contract will be free to do so. I wholeheartedly welcome this development because for too long a monopoly and certain restrictions have held sway. It is important that a change is being made because it will encourage young GPs to establish practices in Ireland and remain here with their families. These individuals have devoted a great deal of time and money to their medical studies and training. It is important, therefore, that we should encourage them to remain here. We should not educate and train them only to allow them to leave and work in other jurisdictions.

The Competition Authority issued its report in July 2010. I am glad the authority did because I was critical of it last night. I am glad that some matters in that report were acted upon.

I welcome the Bill. I look forward to its passage through the House. I am positive about most aspects of it. As I stated, we must never forget the customer is a paying customer, whether under the GMS or a private patient, and he who pays the piper should call the tune. We should never forget - I will not knock the doctors - that the patient must always come first. Some 99.9% of GPs put patients first. Patients must have security of access as well and the GPs must remain there for them. We must examine the unavailability of GPs after hours, at weekends or at night. It is not good enough that one cannot get a doctor. If one is sick, one needs a doctor and one should be able to get one.

See this speech in context