Derek Keating (Dublin Mid West, Fine Gael)

I welcome the opportunity to speak on the Bill. I raise the issue of medical card cover for a patient who is retired and residing in the greater Dublin area but who, for example, has family in Cork, Galway or Donegal. Such a person may decide to stay with a family member for several weeks, for example, in the case of their going on holiday to the family home in these areas. It is important that the medical card cover he or she has for his or her GP in Dublin should cover him or her if he or she needs to see a GP in the locality where he or she is visiting and staying for a short period. It is an issue that needs to be addressed by the HSE.

I welcome the Minister's proposal to deal with the anomalies of the GMS and GP relationship. I hope he will agree it is extremely worrying that a quarter of the population has no health care cover either through a medical card or a private health insurance policy. There is also evidence to show a significant proportion of the population do not visit their GP or access a GP service because of the cost of such a visit, something which was demonstrated very clearly on television last night.

I welcome the principles of this Bill. However, I have concerns. They are based on the fact that our medical service should not be monitored just because of costs to the patient or client. Like our education system, we should have universal medical cover available to every citizen as a right. I welcome this move but health care is not a business. It is much more important than that and, as has been said many times in this House by many Ministers and other Deputies, we do not live in an economy. We live in a society, a community where the welfare of every citizen should be to the fore in all our actions.

Another point I want to draw attention to is the manpower problem regarding doctors graduating and the GP service generally. This has been touched on already but it warrants more attention. I understand in 2005 some 315 graduates qualified in medicine and this figure is expected to increase to 651 by 2014. The number of GP training places will increase from 120 to 157 this year.

I raise this point because the reality is that in some parts of Dublin there are waiting lists to access the services of a GP. In my constituency, Dublin Mid West, it is very difficult to access a new GP. I am aware of the plans to open the new primary care centre in Cherry Orchard Hospital in the new year and I am aware of the effect it will have when new contracts are offered to GPs covering the Palmerstown area.

It is essential that this Bill is successful in addressing the major issues in our health system at the current time. As the Minister is aware, it is the Government's intention to move the direction away from the hospital back to the community using the primary care system as the main focus of health provision for families and individuals. Hospitals are the centres for illness. GPs and primary care centres should be the centres of medical management. A central component of the primary care system is the GP. It is simply unacceptable that our accident and emergency departments have been acting as a filtering service because of the lack of and availability of GPs in our community.

Another essential point that needs to be highlighted is the fact that the Irish population will rise to over 5 million by 2020, which is a little over eight years away. Given that our dependent elderly are encouraged to visit their GPs more and more to anticipate the onset of illness, particularly coming up to the winter months, it is essential that our GP service is capable of taking on the task of providing a primary health service in the community, which is the Government's policy. I am aware that some GP clinics are not accessible by wheelchairs or those with mobility problems. This, too, needs to be addressed.

The Bill will go a long way to addressing many of the issues I have raised. I am fully supportive of the provision in the Bill to remove the restrictions on GPs treating public patients. I would be interested in hearing the Minister's view on the role of HIQA and what its role will be in regard to standards of service provision by GPs. Another important issue is whether there will be a requirement for GPs to publish their fees. something which is required by dentists, solicitors and other professions.

The current cost of visiting a GP ranges from €35 to €80 depending on the area in which the practice is based. Earlier this year the Competition Authority stated this issue was a major impediment for patients who are reluctant to visit their GP at the early stages of the onset of an illness because of the high costs involved.

The difficulty I have with raising this matter is that I do not want to see the health service treated like a business and, although there is an issue around value for money and standards, this is why HIQA should have a role to play in services, cost, quality and the standards practised by GPs.

There are many wonderful GPs who have given a lifetime of service over the years. They are wonderful men and women who have treated their patients with respect, kindness and professionalism, and have done a tremendous job. Society has changed and continues to change.

The availability of information on the Internet has been a challenge for many GPs. Difficulties were raised this week about obesity in children and referring to GPs will be central in dealing with this matter. Other issues such as infectious diseases, GPs dealing with people who are terminally ill and visiting homes at the weekend are all things we need to recognise. We need to thank our GPs who provide such a wonderful service.

I welcome the Bill. When it is enacted it will mean that if suitably qualified GPs decide to set up practice, not alone will they be able to treat private patients from day one, but will also be able to treat patients holding GP visit cards and full medical cards. As I have said, the programme for Government provides for significant strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. This is the key to deliver a universal, community-based equitable health service.

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