Michael Harty (Clare, Independent) | Oireachtas source

On behalf of our group, I express our horror at another terrorist attack on defenceless people, this time in Turkey.

Will the Tánaiste address the status of the negotiations between the Department of Health and the IMO on developing a new GP contract that will allow for the development of a new GP-led primary care model to drive change in our health service? The present contract is 44 years old, outdated and increasingly unworkable. It was introduced to replace the dispensary system, which itself was 100 years old. Thus, the basic contractual structures of Irish general practice have changed only once in the past 160 years, which seems difficult to believe. The present contract was introduced in 1972 to provide acute care for the most vulnerable patients who had medical card entitlements. We have moved a long way in those 44 years and modern general practice has developed beyond the confines of the contract, yet it remains constrained by it.

The future of modern general practice should include providing and leading the management of chronic and acute illnesses. As our population ages, people's complex care increases due to their development of multiple degenerative diseases and cancers. The burden of care for these chronic diseases will be best and most cost-effectively provided in GP-led primary care rather than in the more expensive hospital setting.

The present contract requires GPs to provide 24/7, 365-day services. Most contract holders are working in excess of 60 hours per week. GP workload is increasing due to our ageing population and the eventual extension of free GP care to cover the entire population. Waiting lists to see GPs are developing for the first time, as general practice capacity is being overwhelmed by the increased workload. A new contract is required to expand that capacity and allow general practice to cope with the increased workload of delivering chronic disease management and free GP care to all children. Indeed, it is open to question whether giving free care to healthy children rather than patients with established chronic illnesses is the best way to spend scare resources.

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