Sandra McLellan (Cork East, Sinn Fein) | Oireachtas source

I welcome the opportunity to contribute to the debate on the Bill, the purpose of which is to provide for a free GP service to be made available to all persons aged 70 years and over. It must be noted that this is not the same as a medical card and only allows for free attendance at a GP. It does not allow for medications or other treatments at primary care level. In addition, the Bill provides that a dependant of a person over 70 years of age will have access to a free GP service.

In a separate deal announced in recent days we heard that approximately 270,000 children under the age of six years were to benefit from free GP care if family doctors signed up to a €67 million deal. As Sinn Féin's spokesperson on children, I have a particular interest in this group, but I also have an interest in the welfare of all those under 18 years of age, the remainder of whom will not be afforded free GP care.

At the Irish Medical Organisation's annual conference in Kilkenny recently, the Minister for Health, Deputy Leo Varadkar, spoke about universal health insurance. He stated, ''It's not something to be rushed." We in Sinn Féin disagree with the principle of universal health insurance, a privatisation of health care that direct funds away from front-line services to private entities, regulation and advertising. It should not be rushed; it should be scrapped. Something that should be brought through with great urgency, however, is free GP care for all. A World Health Organization, WHO, report in 2012 recognised that Ireland was the only EU country that did not offer universal coverage of primary care. While the latest announcement should be welcomed, it is but a small measure on the road to levels of service that are accepted as basic across Europe.

The Government has failed to ensure the majority of the population that do not have access to a medical card or a GP-visit cards will have free GP care extended to them. While more than 160,000 people benefit from free GP care courtesy of a medical card or a GP-visit card, the deal will extend care to those children not covered to date. We must remember what was originally promised by the Government, namely, universal access to free GP care for the whole population by 2016. This remains unachieved and we have been given no timescale for the extension of free GP care to the six to 11 years and older cohorts. Extension of free GP care must happen in as short a timescale as possible or a further two-tier system will develop, one in which sick children from families above cut-off levels will have difficulty in affording essential GP visits and medications.

It is only now that we see free GP care being introduced but only for specific groups. This can be seen as the Government acting only as the general election is in sight. We must be concerned whenever anything is described as "medical apartheid," as the National Association of General Practitioners, NAGP, commented on the scheme as it related to the under sixes. Why was the NAGP excluded from the negotiations? We must also know what percentage of doctors the Government envisages will take up the new scheme. We need more detail on many elements. What are the arrangements for children with asthma or diabetes? What does the new scheme mean for those GPs who have expressed difficulty with workloads at current levels? Has the Minister allowed in any meaningful way for an increase in capacity? Certain GPs have warned that this will mean a large increase in workloads for overstretched doctors. As we understand from villages across the country, being a GP in some rural areas is no longer viewed as sustainable. What modelling has been carried out to suggest the system will be able to deal with the predicted extra 4.5 million consultations per year? It is my understanding doctors will receive €125 for each child and €216 for each pensioner whom they sign up under the deal. In return, approximately 300,000 children and pensioners will have free GP visits. Those aged over 70 years generally attend a doctor in or around ten times per year, approximately double the attendance rate of children.

The HSE has stated it hopes to commence patient registration in May and have all of the arrangements for the commencement of the service complete by the end of June. It will advise the details in the coming weeks and I understand contracts to GPs are to be issued in May, with registration by July.

There are some issues surrounding registration for free GP care. Parents must register with the HSE in advance. We must be assured this will not disqualify some patients. Will the Minister of State outline what information will be needed in making applications? It is unclear if the PPS numbers of children or their parents will need to be provided to access the new cards.

Processing more than 250,000 applications for free GP care for children under six years of age by July will also pose a challenge. What do the Minister and the Minister of State intend to do to ensure this happens without major hiccups or delays? When will primary and second schoolchildren be accommodated for free GP care?

The fundamental challenges facing the health system must remain centre stage and deserve to be tackled with equal vigour. The numbers on waiting lists for outpatient appointments to see specialists have topped 400,000. Almost 70,000 adults and children are waiting for surgery or hospital treatments. Many families visit my constituency office regularly because waiting times are so long. Some people have been confined to wheelchairs while they wait for hip replacements. Many are taking out loans that they can ill afford because they are in so much pain.

These issues remain crippling realities for the population. The Minister has described the moves as "the widest extension of eligibility in the health care service since Erskine Childers brought in the first GMS contract almost half a century ago and wider than the mother and child scheme before that." It must be noted again that Ireland is the only state in Europe with such a system.

The National Association of General Practitioners has indicated that a total of 5,000 Irish people die from cardiovascular disease every year, but there is nothing in the Bill to support that group or any other specific group. What does the Government propose to do for this group of citizens and similarly vulnerable groups?

Some of the fine print details of the scheme for the under sixes need to be clarified. For example, the proposed asthma scheme will only be available to children aged between two and four years. This smacks of a political stroke. The under sixes scheme will exclude provision for medicines, X-rays, blood tests and emergency department visits. In addition, parents will have to pay a private GP fee if they take their child to be seen in one of the doctors' co-operatives outside normal working hours. The scheme for those with diabetes, meanwhile, is very limited and will only be available to those who already qualify for a medical card or doctor-only card.

Will the Minister of State outline how the need for investment in general practice will be filled? Rural practice, general practice in deprived urban areas, comprehensive chronic disease management and other existing services are all challenged. Will the Minister of State provide an update on the drawing up of a new GMS contract?

Sinn Féin will support the Bill, with the proviso that the Government must act urgently and give a timescale for when free GP care will be extended to all members of society.

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