Dara Murphy (Cork North Central, Fine Gael)

I welcome the opportunity to speak on this Bill. I must admit I got a fright a minute ago when I heard the Deputy opposite calling for the establishment of a contract between GPs and the State, even though we are here to speak about the contract that already exists, which we are seeking to amend. I am not exactly sure what he was talking about but, as the French would say, plus ça change - nothing changes there.

The Health (Provision of General Practitioner Services) Bill will enable a wider range of registered medical practitioners to provide medical services to eligible persons under the existing contract, the GMS scheme, and provide for the necessary modifications and related matters. If one takes a very narrow view, it is correct to say that there is a commitment under the EU-IMF programme we have inherited that various measures will be established by the Government. However, we must also acknowledge that, by virtue of the fact that we functioned without a Government for many of the last 14 years - before February of this year - much of what the Government is now putting in place is purely down to good governance rather than to some albatross that has been unfairly placed around our necks by a third party that is interfering unnecessarily with our affairs.

I spoke last week on a similar issue, that of competition in the energy supply sector. Again, this was one of the projects we committed to undertake during the third quarter as part of our programme. It must be acknowledged that, while we are working through the programme, it is nonsensical and irrational to suggest that every element, or even most elements, of the EU-IMF programme are to the disadvantage of our country. In fact, the contrary is the case.

The Minister is here with us. Primary care and GP provision are in many ways the areas of the health service that have functioned best to date. People all over the country interact with their general practitioners and have good relationships with them. Thankfully, for most people, the main area in which we engage with health services is through our general practitioners. They, their staff and their surgeries are a resource that needs to be developed and used, not just for saving money - though I believe they are a significant benefit to the State - but because they provide a far superior way for patients to engage with their doctors. I call on the GP groups and medical organisations to embrace the great work the Minister has done to date in encouraging far greater use of general practitioners and the primary care model. I take this opportunity to welcome the announcement in the recent capital budget of the Government's strong commitment to the development of the primary care model - especially, to be parochial, in my own area of the north side of Cork city - and I urge the Minister to continue on this very good path.

A consultant in emergency medicine pointed out to me that 85% of the people who come to his accident and emergency department are what he refers to as ambulatory - in other words, they walk in and walk out. He suggested that many of them need not be there at all. By virtue of the purpose of accident and emergency units people who present with a greater degree of medical distress must be treated first and no one could dispute this.

However, we must continue to encourage people to bypass, where possible, the feeling that they should go to an accident and emergency unit. To do so, we must continue to reform and improve the system under which general practitioners provide their services. This is the main provision of the Bill. At present GPs only obtain general medical services, GMS, contracts in restricted circumstances, for example, where a vacancy arises through retirement, resignation, where the death of a GMS doctor occurs or where a new GMS panel is created in response to a specific, identified need for an additional doctor in a given area. However, given the current lack of growth in population in most of the country this is unlikely to arise much.

The Bill will open up access to GMS contracts to all fully qualified and vocationally trained GPs. There will be no limits of contractors and this should be welcomed. There is a point to the effect that medical services should not be viewed in a cold, economic, mercenary or competitive business environment. However, at the same time people who are qualified in the same fashion as other medical practitioners and who have contracts should be entitled to a reasonable expectation that they will be able to provide the services for which they have been trained, by virtue of the significant cost the State has invested in them and the significant costs and time they have invested in becoming qualified.

Another issue arises which has been brought to my attention by general practitioners. This is somewhat of a digression but it is a medical issue. There is a social cost in our society related to general practice and how those involved engage with it. The area of alcohol abuse and how it is damaging the health and wealth of the people may need some regulation from the Government. I have long held the view that we should increase the permitted age for the consumption of alcoholic spirits in our country to 21 years. I do not include beer and wine in this proposal. There are significant social costs from the practice and it has changed from my time, when people would drink pints and ease in to what is accepted as a part of our drinking culture. However, now there is too much consumption of spirits. While the American model of prohibition of any alcohol consumption up to the age of 21 years is going too far, there is a strong case for some measures. I urge the Minister to examine the issue. There is a case to be made whereby people would not be allowed to drink more damaging spirits until they have more experience in the matter.

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