Jerry Buttimer (Cork South Central, Fine Gael)

I very much welcome the opportunity to speak on the Health (Provision of General Practitioner Services) Bill - the Title of which is important. I welcome the Minister of State, Deputy Shortall.

It is vital that the health service is undergoing transformation. People have legitimate concerns regarding the condition of the health service and the type and quality of the health service being provided.

I welcome the appointment of Deputy Shortall as Minister of State with responsibility for primary care. Given the importance of her task, she is a critical part of the Government and her appointment demonstrates its commitment to the primary health care of the people. Speaking as someone who admires the Minister of State, I am thrilled that, given her many years in the House, she has been given this responsibility. She has the political determination and vision to get the job done with the Minister, Deputy Reilly. It is important that we pay tribute to her.

It is also important that we support workers in the wider health service and that they see the Government as being willing to embrace change within the service. As the Minister of State knows, the programme for Government is ambitious, in that we are committed to the development of a single-tier health service, one that guarantees universal access to medical cards based on need, not income. We must move away from an income-based health model.

Deputy Fitzpatrick was correct, in that this proposal fulfils our commitment in the EU-IMF memorandum of understanding, but we must put it in context. Under the memorandum of understanding, the Government will introduce legislative change to remove restrictions to trade and competition in sheltered sectors, including medical services. It will eliminate restrictions on the number of general practitioners, GPs, qualifying, GPs wishing to treat public patients and advertising. For these reasons, the Bill is important. It will provide greater choice, the buzz word in this debate. Choice is important.

Equally, the relationship between GP and patient is of critical importance. As a non-medical cardholder, I have a choice. I attend my GP because I like, respect and trust him. He is competent and capable and will look after me.

The 1989 agreement with GPs enshrined restrictive practices, closed routes of entry into the general medical services, GMS, scheme and limited the number of GPs who could participate in the scheme. In effect, it ensured there would be no competition. A new GP could only participate if a doctor retired, resigned or died; if there was an identified need for an additional doctor, or if a GMS doctor required an assistant. Even if these criteria were met, the shelter was reinforced by the requirement for the HSE to consider the viability of existing practices. The interim entry provisions were negotiated in 2009 and further strengthened restrictive practices. Under the scheme, medical card patients were not allowed to transfer from one GMS doctor to another. For years the HSE, the Department and the medical profession have worked together in establishing a sheltered environment in which to practise. Some might say a cartel was in operation. As much as the doctors themselves, previous Governments were responsible for promulgating restrictive practices. It is essential that the patient be put at the core of everything we do. Given that, in this instance, the patient's interests lie in reform, it is important that reforms be enacted.

The changes will have an immediate impact on approximately 400 practising GPs not currently part of the GMS scheme. If they so choose, they will allow them to participate in the scheme and access their own GMS lists. They will also allow doctors working as assistants under the scheme to branch out on their own, further augmenting the themes of change and choice. The effect of the changes will be increased competition. The House discussed the Competition (Amendment) Bill this week. Today, we are discussing legislation that, as the Minister stated at the beginning of the Second Stage debate, will result in medical card and GP-only medical card patients having a greater choice of GPs.

The changes to be made under the Bill will benefit newly qualified GPs and those who choose to return from training overseas. It will immediately make it viable for newly qualified GPs to open practices. The Minister of State must consider how to reach out in order that communities will have a greater choice and the responsibilities thrust upon many hospitals' accident and emergency departments can be diminished. We must move away from the first port of call being an emergency department. We must teach people that presenting at an emergency department immediately is not necessary in every case.

During the past six months we have been made acutely aware of the shortage of non-consultant hospital doctors, NCHDs. The Joint Committee on Health and Children, which I am privileged to Chair, has met all of the interested parties to discuss the reasons for the shortage and how to solve the problem. Some believe we are only sticking a Band-Aid on it and that we have not addressed the critical issue and thus will not prevented a shortage from recurring. Owing to a lack of training opportunities and career development and advancement options, many doctors trained in Ireland have opted to work abroad. Many also train abroad. Eliminating certain practices under the GMS scheme will provide an opportunity for more doctors to remain in Ireland. We want to keep as many doctors as possible here, as Deputy Fitzpatrick mentioned.

For medical card patients, the only way doctors can compete is not through price but through quality of service, having a special relationship built on a caring, competent and professional one-on-one interaction. The Bill will remove the requirement for the HSE to consider the viability of practices. It will be for each GP to ensure his or her practice meets the best standards in order that it can attract new patients and expand. This is a matter of providing for a greater variety of service choices. I hope the Bill will impact on the charges for private patients. If doctors open new surgeries to cater for GMS patients, they will also need to attract private patients. It is important, therefore, that the price issue be tackled by GPs. I hope pricing, a key issue, can be considered by the House in the future.

Patient care is important. We must acknowledge the great work being done by GMS scheme GPs working in communities. In many cases, they deal with elderly, vulnerable and disadvantaged patients. How will the umbrella organisations, namely, the Irish Medical Organisation, IMO, and the Medical Council, and vested interests react to the relationships outlined in the Bill? Is it the case that the representative groups are stating one thing and doing something else? Are they merely lobbying to protect their members' interests, as is their entitlement? In the overall context of the Bill, it is important that a balanced approach be taken and that there be competition to deliver better outcomes for patients. The organisations should not use words that could be translated as meaning they opposed the Bill or would not take care of patients. The IMO and GPs have a great role to play in targeting the delivery of health care services.

Reform in the wider health sphere is essential. I hope we will consider the HSE and its role in the outputs of the health service. Instead of protecting existing practices, we should provide opportunities to be bold, innovative and expansionary and create new partnerships and primary care policies.

The Minister for Health is a reforming doctor, while the Minister of State has vision and determination. Both have knowledge of the GMS scheme and are leading the charge for change.

See this speech in context