Peter Fitzpatrick (Louth, Fine Gael)

One of the results of the programme introduced by the EU-IMF is the provision to remove restrictions to trade and competition in sheltered sectors by the end of September 2011. This encapsulates restrictions on general practitioners wishing to treat public patients. It is with this in mind that the Bill provides for the elimination of restrictions on GPs wishing to treat public patients under the General Medical Services, GMS, scheme.

Essentially, the Bill will open access to GMS contracts to all fully qualified and vocationally trained GPs, subject to general suitability criteria. This will ensure greater benefits to all stakeholders, in particular the public and patients.

At present the entry terms to the GMS scheme form part of the 1989 agreement with GPs. There are three routes for entry into the GMS scheme for GPs: where a vacancy arises due to the retirement, resignation or death of an existing GMS doctor; where a new GMS panel is created in response to an identified need for an additional doctor in an area; and where a GMS doctor obtains approval from the HSE for the creation of an assistant post with a view to partnership within his or her practice.

Developments in primary care should always build upon and add to the strengths of the current system. This Bill ensures an enhanced provision for the patient, and for this reason and many others I have no hesitation in supporting it.

Historically, GPs, public health nurses and other professionals have provided primary care in Ireland. They have provided a critical front-line service which has acted as a gatekeeper for many secondary elements of the broad range of health and personal social services. In many cases, and for long periods, it has been the commitment of such professionals in primary care which has ensured the public has been able to avail of a personal, local, accessible and timely service with which they have been satisfied.

As mentioned, the legislation will create a more open playing field with all suitably qualified GPs being able to access GMS contracts. The most fundamental aspect of the Bill is that there will be no limits on the number of contractors.

New GMS contract holders will be free to establish their practice in the location of their choice, but once established, any contract holder who wishes to move location will only be able to do so with the prior approval of the HSE. This is designed to ensure continuity of care for patients. The fact this Bill ensures there will be no limits to the number of contractors clearly complies with the EU-IMF programme, removing restrictions to trade and competition.

This Bill has two main strands. In the first instance, as mentioned previously, it fulfils the requirements established by the EU-IMF. Second, and more importantly, it confers numerous benefits on the State and, therefore, on patients.

The enactment of the Bill will result in medical card and GP-visit card patients having a greater choice of GPs under the GMS scheme. This should not be underestimated, particularly in the less populated towns and villages of the country. Greater choice can instil better confidence in patients and ensure they are not compelled to return to a practitioner where they may have had an unfavourable experience.

In addition, the greater range of service providers in an area should ensure they deliver a better service to the patient. By this, I mean they may effectively compete for custom in many ways. Examples include extending opening hours, opening on Saturdays and Sundays, providing better waiting and parking facilities, investing in the latest technology, and providing the latest advances in treatment and diagnosis. All these aspects help improve the delivery of services to the patient.

This Bill will ensure that any suitably qualified doctor who wishes to obtain a GMS contract will be free to do so. Thus, those with drive, passion and enthusiasm will be rewarded and, more importantly, afforded the opportunity to excel in their profession. By allowing greater access to such practitioners, it will also greatly raise the standard of delivery and patient care.

This Bill will also encourage young GPs to remain in Ireland and to establish their practices here. As has been all too often documented in the media recently, we are losing vital and crucial talent through emigration. This Bill will in a strategic way help address the export of our young GPs, the very core of our future improved health system. After all, it is these young men and women in whom the State has invested, via the provision of education and universities. It is imperative that we try to arrest their decline and encourage them to stay within our shores.

Furthermore, this Bill will encourage competition among GPs at a time when many fee-paying patients have less money at their disposal. This competition will ensure a greater choice for the patient and in doing so, will put downward pressure on charges. This can only be of benefit to our already financially-stretched people.

Another aspect of this Bill that ought not be overlooked is that the extra GPs should ensure greater provision of front-line services, therefore reducing some of the supply to the over-stretched hospitals. This aspect of the Bill will have a preventative element and will help ensure a better delivery of services at both GP and hospital level.

The current capacity of primary care is insufficient to meet the evolving needs of the population. Changes in demography, reorientation towards prevention and health promotion and shifting the focus from secondary care towards primary care will increase the burden already facing community services. This Bill addresses in an effective and fundamental way these issues.

I alluded to the fact that GPs provide a crucial gatekeeper role to secondary care services. Studies have shown that patients value this gatekeeper role and it has also proved to be cost-effective. Greater availability of GPs will further cement this vital and sometimes underestimated role.

In addition, this Bill may reduce the strain on an already under pressure secondary care sector. The secondary care sector is providing many services which are more appropriate to primary care. This Bill has the potential to address this over-reliance on secondary services. Essentially, by providing greater access to and choice of primary care, it will reduce the pressure on secondary care providers.

A further aspect of the Bill that warrants mention is that it affords the potential to facilitate and develop otherwise underdeveloped out-of-hours primary services. It has the scope to provide greater choice and service to the patient, with resultant benefits to hospital accident and emergency departments.

Finally, I want to address another commendable aspect of the Bill. In addition to the already stated benefits, this health Bill will further address the following recommendations in the Competition Authority's July 2010 report on general medical practitioners, which was aimed at increasing competition within the GMS scheme: access to GMS contracts should be opened to all qualified GPs, decisions to award a GMS contract in a particular area should not take account of the viability of GPs already practising in the area and GPs in possession of a GMS contract should be free to set up in, or move to, the location of their choice.

I have no hesitation in recommending this Bill as it has a multitude of benefits to both the State and the people. By opening GMS contracts to all fully qualified and vocationally trained GPs, this is welcome and timely legislation.

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