Heather Humphreys (Cavan-Monaghan, Fine Gael)

I welcome the opportunity to speak on this important Bill. Its objective is to remove restrictions on general practitioners entering the medical card market. Given that there are approximately 1.7 million medical card holders in Ireland, any changes to the current system will have a broad-ranging impact. The agreement with the EU and the IMF provides for legislative changes to remove restrictions to trade and competition in sheltered sectors by the end of the third quarter in 2011. In effect, this legislation is a response to that requirement in respect of general practitioner services.

The Bill provides for the elimination of restrictions on GPs wishing to obtain contracts to treat public patients under the general medical services scheme. This will in turn open access to GMS contracts to all fully qualified and vocationally trained GPs. Medical cards and GP visit cards are an absolute necessity for those on low incomes. Under the proposed changes to the GMS contract system, card holders will be provided with greater access to GP services. These changes will mean better choice and quality of service for all patients and increased value for money for consumers.

Under the current arrangement, the level of competition between GP practices in certain areas is limited. There are only three routes for entry into the GMS scheme: first, where a vacancy arises due to death, retirement or resignation; second, where it is identified that there is a need for an additional doctor in an area and; third, where a GMS doctor obtains approval from the Health Service Executive for the creation of an assistant within his or her practice. In addition, the HSE is required to take account of the potential viability of a new GMS practice in the context of existing GP practices in the area.

The changes proposed in the Bill mean there will be no limit on the number of contractors and all new GMS doctors will be free to establish their practice in the location of their choice. It is important that the establishment of practices should be monitored by the Department. While increased competition is a healthy development, there should be an element of caution applied. We do not want a situation where doctors will only set up practice in urban areas where there is a higher population density. It is important that rural areas should be covered adequately. In my constituency, for example, County Monaghan has one of the lowest ratios of GP per head of population. With that in mind, there should be incentives for GPs to set up practice in areas which currently have limited services.

Concerns have been raised in regard to the potential effects of these provisions on the doctor-patient relationship. In particular, there has been reference to the potential for this approach to promote "consumer-driven medicine" whereby patients will chop and change between different GPs, which will ultimately have a negative impact on the level of care they receive. These are genuine concerns and it is important that they be addressed.

The Bill includes a provision whereby, once established, any contract holder who wishes to move location will be able to do so only with the prior approval of the HSE. I welcome this provision as it is designed to ensure continuity of care. Many patients, particularly elderly people, become accustomed to their local doctor and find it extremely difficult to engage with a new practitioner. Once established in a local community, it important that doctors do not leave without good cause.

One of the key objectives of the Bill is to encourage young GPs to remain in Ireland and to establish their practices here. The large number of young, talented people in the medical profession who have been leaving Ireland to seek work elsewhere has been well documented in recent years. These people, in whom the State is investing, receive their education in Ireland only to depart once they have completed their studies. We need to do all within our power to ensure that these people remain in Ireland as these are the exact types of people who will ultimately help to improve the health services in this country. We cannot continue to simply educate our young doctors for export.

As well as being a requirement of the EU-IMF programme, the Bill also addresses a number of recommendations set out in the Competition Authority's 2011 report on general medical practitioners. In this respect, I note that the Competition Authority has responded very positively to the publication of the Bill, describing it as "great news for everyone who goes to a GP". While I largely concur with those sentiments, I think it is also important to point out that GP practices are not like convenience stores. The local GP represents an integral part of any community and in that respect there should be clear distinctions between quantity, cost and quality in respect of GP practices when compared with other industries.

I agree that an increase in competition is healthy, however, as with any other enterprise the ultimate goal should always be to encourage better services and in this instance better quality of care for patients. I welcome the Bill and commend the Minister on introducing it. I have no doubt it will have a very positive impact for the patient.

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