James Lawless (Kildare North, Fianna Fail) | Oireachtas source

I welcome the Bill, which contains a number of miscellaneous provisions relating to the health area. I will comment on one or two of them but I will also suggest some areas not included in the Bill that require attention from the Department of Health in the very near future if not in this Bill.

We heard mention of an issue this morning on Leaders' Questions when Deputy Harty, on behalf of the Independent Alliance, spoke about rural services provision. He was speaking about post offices but he is probably better known for talking about GP services. He mentioned the phrase "no doctor, no village", which I have become familiar with in recent times. Although this may be associated with the western seaboard or quite rural areas, the issue is becoming apparent right around the country, with rural GP and health care services being eroded. The Department and the HSE have not been proactive in replacing these.

A particular issue arises when those who live in localities are very dependent on their community GPs. We heard, correctly, for many years about the need to move towards primary care as the first point of service provision so that as much as possible can be done at the first point of contact by bringing care into the community and the home in some cases. This is a very laudable and sensible approach. Unfortunately, however, it depends on individuals and, like many things, the practice of health is subject to market forces. It is of mixed nature as there is serious public intervention as well but we cannot control where individuals choose to practice. An issue arises when a GP provides a very valuable service to communities but decides not to continue servicing those communities because of economic reasons - it may be unviable - or, as in my own constituency of north Kildare, around Johnstown Bridge and its surroundings, a rural GP may retire. Retirement is a normal life event for everybody and a GP is absolutely entitled to do this but it can be very difficult to find a successor. There are 6,000 patients in the surgery in my area and they now have nowhere to attend. A locum is in place but it is restricted, down from 100 hours to 18 hours on an interim basis. This leaves a number of people in rural communities very exposed and it is a particular issue, as I have said, in Johnstown Bridge in north Kildare, although it is happening across the country. The more I investigate, the more I hear about it in other constituencies. It is an issue at national policy level that must be addressed. The HSE, the Department and, perhaps, the Minister must become more proactive in highlighting this. Forward planning plays a huge part in identifying where a GP is likely to be retiring and what steps can be taken to replace the GP in time.

As I have stated, it is a mixed market and there are elements of the general medical scheme and public patients attending practices along with private patients. The difficulty is one of one of economics as the public practice may not be enough on its own to sustain a GP practice, so a private element is needed. In Clare, Mayo and Kildare I have seen that the process of replacing a GP takes so long that the practice dissipates to the four winds and there is nothing to take over once three, six or 12 months have elapsed. I understand that this was addressed in the programme for Government and it was certainly the subject of talks relating to the formation of the current Administration. I am not sure how far that got but it is something that needs to be highlighted on a national level. I hope we can see movement on it, perhaps not in this Bill, but at a future stage. There is a need to be cognisant of the gaps arising in rural communities, where GPs are retiring - a natural life event - but not being replaced, as well as the health economics around that.

Measures such as the rural practice allowance were traditionally associated with practices with a large rural catchment area and General Medical Services scheme. In some cases that measure has been taken away and I understand it was replaced in the programme for Government. Regulations were updated but in many cases pared back. The net effect is that many places no longer have community GPs. Where there was a GP and he or she retires, the process of replacing him or her is so cumbersome and elongated, there is nothing left to take over in some cases. People then go to towns and primary care centres where that is possible but many elderly people in particular do not have the option. From a policy perspective, forward planning would not be terribly difficult as this manifest itself again and again. I hope I will still be in this House in a few years but I hope I will not be talking about this and it will have been addressed in the mean time. Right now we can examine the ages of GPs in rural areas across the country and when they can be expected to retire.

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It seems that the process of recruitment and replacement only kicks in at that point. Surely it should be kicking in much earlier in order to enable forward planning. This is a serious issue in rural areas where people, particularly the elderly who cannot travel to other towns to avail of medical services, feel exposed and vulnerable. I ask the Minister to examine this issue. If provisions were included in this Bill, I would welcome them, especially around the rural practice allowance and other supports to maintain rural practices but perhaps that would be better done through another vehicle.

There are many provisions in this Bill related to pricing, how the system works and various pricing structures. Prescription charges are a cross to bear for many older people. While a €2.50 charge may seem like a small amount of money, it is a lot to some people, particularly pensioners who have very limited means and are living on a fixed income. Fianna Fáil believes that the prescription charge should be abolished entirely and I hope we will see some movement on that in next week's budget. There is nothing in this Bill that deals with the issue of prescription charges but I await next Tuesday's budget with great interest and expectation in that regard. Prescription charges are a burden on older people. I have spoken to many people at my clinics - as have many other Deputies no doubt - who have told me that they are afraid to fill their prescription because their income is so limited and they are afraid of what they might be left with at the end of the week. They are taking a chance and deciding to do without their medication because of the limited money in their pocket and the need to put bread on the table. The cumulative effect of this is that older people are exposed and more vulnerable. Fianna Fáil firmly believes that prescription charges should be abolished if at all possible. As I have said, I look forward to seeing if prescription charges are on the agenda next Tuesday.

The problem with rural GP practices must be addressed. I have seen in my own constituency and in many areas across the country that when rural GPs retire, they are not being replaced quickly. The process of replacing them takes so long that the practice is dissipated. People are left exposed and vulnerable and find themselves having to travel to see a GP, while some are not able to travel at all. The entire recruitment process must be overhauled. Supports for rural surgeries and practices also need to be overhauled. The rural practice allowance and other measures must be re-examined. Again, I hope to see movement on the issue of prescription charges which are a burden on elderly people.

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