Simon Harris (Wicklow, Fine Gael)

I welcome the opportunity to speak on this Bill, which is a welcome and important initiative in the development of our community-based health care services. In the pre-election manifesto of Fine Gael and in that of our colleagues in the Labour Party, we made a commitment to remove restrictions to trade and competition in sheltered sectors and I am pleased to see this commitment is now being honoured with the abolition of the current restrictions on GPs seeking to treat public patients. As we enter a budgetary process dominated by many difficult decisions imposed by the EU-IMF agreement, this is one of the more welcome elements.

I believe in a health care system where, in so far as possible, patients can access the care they need in their community. The roll-out of primary health care services is about much more than the provision of GPs but GPs will have an integral role to play as an element of that service. I welcome the Minister's commitment to addressing the current inequity in the way GMS lists are awarded by the HSE and, in particular, the removal of the requirement that the HSE consider the impact the awarding of a list would have on existing practices within the locality. All too often, the closed GMS list currently operated by the HSE takes choice from patients. It is important that any public health service puts patient choice at the centre. Anybody who has had reason to interact with the health service will recognise it can be a very stressful and frightening time. Having a GP who one respects and has an ongoing relationship with can be a huge support in such difficult times. However, the current system works against patients, often requiring them to move to a new GP if they need to access the health care system using a medical card.

It is my understanding that this affects primarily two kinds of patients - the first is those whose circumstances have changed in our challenging economic times and now access their GP through the public medical card system. The second is those who qualify for a discretionary card on the basis of a medical diagnosis. Under the current system, these patients are often required to leave their family doctor, who knows their history and with whom they have an built up a rapport often over years, and to attend a GP holding a GMS list granted by the HSE but who may have no knowledge of, or involvement with, that patient or the family. This Bill will restore choice to these patients, empowering them to choose who provides their care and to stay with the doctor they know and trust. This is a welcome development and I thank the Minister for bringing the Bill before the House.

As we move towards a system where more services are based in the community, and are accessed through local GPs, it is vitally important that GPs have the skills and patient knowledge they need to provide the best possible standard of care. Consequently, we must ensure that the brightest and the best qualifying GPs recognise that there are opportunities for them in Ireland. At the moment, the system works against young doctors as they are not entitled to treat any public patients until they have a contract with the HSE. This can take several years to obtain. The provisions of this Bill are therefore very important in ensuring we have a suitably qualified workforce in place to support the move of services from a hospital setting back into the community. I welcome the opening of the GMS system to competition as it will make it easier for young, ambitious and talented doctors to establish themselves in Ireland without having to break into existing practices and the closed shop arrangements of the HSE.

Opening up the area of general practice to increased competition will not just benefit public patients but all users of the service, as GPs will be forced to become more cost effective in the way they run their practices. They will also have an incentive to provide a wider range of services to their patients. This will take place hand in hand with the commitment in the programme for Government to deliver universal primary care to patients without any cost barrier and to alleviate the pressure currently seen in our accident and emergency units.

As a Deputy representing a constituency with urban and significant rural areas and with many houses and families spread out over a wide geographic area, I am keenly aware of the need to ensure that all residents in my constituency will be able to access the same standard of care. Anecdotally, I have heard tales of rural practices struggling to attract GPs, either on long-term or short-term contracts, due to the differing requirements of the role, such as the need to make time-consuming house calls in remote areas. As we move towards a more equitable, but also a more competitive system, we must ensure patients will be able to access the same standard of care regardless of where they live. We cannot allow a situation to arise where rural residents are deprived of the same standard of care as their urban peers due to urban areas being seen as more profitable. We cannot have quality health care delivered on the basis of postcode. I ask the Minister of State, Deputy Shortall, to keep this under consideration as she embarks on playing a major role in the reconfiguration of the health care system. It is important that we look at the role of the GP in terms of the reconfiguration of the health service. As we move towards providing more services within the community, we must look at other stakeholders and professionals within our health service and the enhanced role they can play. I refer to community nurses in particular. In other systems in the EU, many more services are provided by nurses than GPs. It is a cost-effective way of delivering services and it is a way of recognising the qualifications and training of these health professionals. It also alleviates pressure on GPs and from an economic and social point of view, it keeps people out of hospitals. This Government is determined to rectify the mistakes of the previous Government, which threw billions of euro at the health service without delivering any real and meaningful change. By the end of this term of office, we will be well on our way to delivering free GP care and putting in place the infrastructure for it. This is an important Bill, which is part of the EU-IMF agreement. Regardless of that, the Fine Gael Party and the Labour Party feel strongly about it. I welcome this legislation and thank the Minister for introducing it.

We must have a broader discussion about the role of community health care. This should not just be based on medical cards and doctors and we need to hear details in the coming weeks about our primary care system. In my constituency, where there has been talk of reconfiguring the hospital service, it is important to show people that we are serious about not only closing existing services based on promises and the nirvana that has not been delivered in the past despite promises and economic wealth. We need to have our ducks lined up correctly. Throughout the reconfiguration of our service, we need to make it clear to people that the roll-out of primary care goes hand-in-hand with reconfiguration. While the Minister of State, Deputy Shortall, is in the Chamber, I stress the need to examine the roll-out of primary care centres. She has done much work on this. In my constituency, there are large urban areas such as Bray and Greystones where people are needlessly going to hospitals for services that could be provided at the local level. This would be beneficial from every point of view, including traffic, the environment, the economy, a sense of community, spin-offs for other GP practices and benefits to doctors.

This is an exciting time to reform the health service. In the past, increasing the budget has not delivered improvements and better results. I have seen this in my constituency. We must reform within a difficult financial situation. It is difficult to reform when funds are not available given that we must bring people with us. There is always a fear that the Government will introduce reforms to save money. We must explain to people that, while change is always difficult, reforms are in their interest. When this Government leaves office, we will not leave glossy reports on the shelves. We will have made a real difference to people's lives, which is what I want to see in Bray, Greystones and across my constituency. This Bill is a start and there is a long way to go. The Government has been careful to outline that change will not happen overnight.

It is a process and in that regard this legislation is very much a welcome start. I commend the Bill to the House.

See this speech in context