Michael Harty (Clare, Independent) | Oireachtas source

I am grateful for the opportunity to contribute to this debate. FEMPI was introduced in 2009 during our financial crisis. Yes, it was an emergency. However, the FEMPI legislation was so harsh that it was similar to legislation which would have been introduced during war times. It is now seven years later and we still have FEMPI. It is a pity that we did not have this debate prior to the end of June when the FEMPI legislation was signed again for another year. I agree with many of the other speakers that there needs to be an unwinding of FEMPI. It needs to happen very quickly because it has led to a large inequality in our public service and certainly in the payments to our public servants.

We know about teachers. They have lobbied us extensively over the past month. The figure of €240,000 over the lifetime of a teacher has been mentioned here. Not only that, but there are teachers doing the same job and working beside colleagues who are being paid 20% extra. That is completely unacceptable. It also applies to nurses and gardaí as well as pharmacists and doctors. There is a huge range of public servants who are subject to FEMPI. It is quite intolerable that this financial emergency measure is still in place in 2016 when we are told that the recovery is here and is spreading across the country. Unfortunately, it is not here and it is not spreading to our public servants.

In relation to doctors and to general practice in particular, FEMPI has been very harsh. It has been harsh on general practice because of the method that GPs are paid by. GPs are paid a global fee which includes their income as well as the support structures for general practice. We have suffered a cut of 38% under FEMPI. That is a cut of 38% to our income, to our ability to supply services and to the support structures that supply services. If one was to go through the figures, one would clearly find that the cuts to supports for services are even greater than 38%.

What has this meant for general practice? It has meant that general practice is now on the brink of going into decline. It is facing such a financial crisis that many GPs are finding it very difficult to make an income. Practices are ceasing to function. There are GPs who have left with their families and gone to Australia, Canada and the Middle East to try to make an income. Income which they can generate from general practice with FEMPI still in place is not sufficient to make a decent standard of living. GPs have absorbed the FEMPI cuts. Very few people will have seen a decrease in the service they get from their GP. The GP is the last person to be paid in a practice. Everyone gets paid, including the nurse and the secretary. Quite often, the income to general practice does not make general practice sustainable. I know that doctors do not have much sympathy in Ireland because we are seen to be making a very good living. Since FEMPI has come in, that has changed. Practices are ceasing to function, GPs are emigrating and there is a huge manpower crisis which is coming down the road in general practice.

We hear that the new ten-year vision for health is going to place a great emphasis on primary care and general practice. The manpower crisis in general practice will mean that the manpower will not be there to supply that expansion of service into primary care because GPs are finding it extremely difficult to continue under our present payment system. We have been asking and asking for the last number of years for a new GP contract, which will hopefully come within the next year and will help to unwind FEMPI for GPs. The effects of a declining general practice on our health system is quite extraordinary. If most chronic illnesses are going to be transferred into general practice and primary care, the GPs are not going to be there. We have a problem with emigration, as I mentioned. Established practices are closing and those doctors are moving to other jurisdictions where the health service is much more user-friendly, friendly to those who participate in it and friendly to those who supply the service.

In Ireland, we have an extraordinary number of medical schools which produce a huge number of graduates every year. Our GP training schemes, which had been oversubscribed, are now barely able to recruit those sufficient numbers for training. The GPs who do come out are looking at general practice and because of FEMPI are saying that they are not going to enter into a contract which commits them to working 24 hours a day, seven days a week, 365 days a year, in which they have all of the expenses and commitments that go with running a practice. They are leaving and going to Australia, New Zealand and Canada. They are deciding not to take up general medical services, GMS, contracts and are instead working as sessional GPs or locum GPs.

The reason why we still have a GP service in this country is because so many GPs are embedded in their practices and have nowhere to go.

They cannot leave their practice, it is their way of life. Some 33% of GPs will reach retiring age in the next ten years. As those GPs come to retire, however, there are no entrants coming in to replace them, or certainly very few. There is therefore a huge GP crisis coming down the road and it has been accelerated and exacerbated by the introduction of FEMPI. FEMPI will have to be unwound, although I know it has become tied up with the Lansdowne Road and Haddington Road agreements. It is a matter of extreme urgency that FEMPI is unwound so public servants can have equal and decent pay.

All legislation has unintended consequences. One of the great unintended consequences of FEMPI is that it has made general practice completely unworkable. That matter should be addressed soon. I urge the Minister and the Government generally seriously to examine FEMPI. If our financial emergency is over then the legislation which underpinned it should come to an end also.

It is unfortunate that this debate is happening after the FEMPI legislation has been renewed for another year. When it comes up for renewal next year, I hope the Minister will contemplate its unintended consequences which have been disproportionate to general practice. The legislation has also been disproportionate to many other public servants such as teachers, doctors and nurses.

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