Michael Harty (Clare, Independent) | Oireachtas source

At the outset I wish to declare that I am a registered general practitioner. When I started in general practice many years ago my medical indemnity insurance was £40 but now it is €14,000, which will give Members an idea of the increase over the years. It is essential that a general practitioner, or any doctor practising in a specialty, has medical indemnity insurance and, having always worked in the public system, I was not aware that it was not a requirement of the Medical Council that a doctor have evidence of medical indemnity insurance. It would be a very brave doctor who practised without it but it is only a factor in private practice because, in the public health service, a doctor would not get paid without insurance so he or she has a great incentive to have it.

Deputy Alan Kelly wondered what the costs of medical indemnity insurance were and how they were arrived at. There are three companies providing medical indemnity insurance: the Medical Protection Society, the Medical Defence Union and Medisec, which is an Irish organisation. Actuarial evidence is used to determine how medical indemnity insurance is set for each medical specialty. For a general practitioner the amount is lower, at €14,000, but for an obstetrician or an orthopaedic surgeon it can go up to €150,000 because of the much greater chance of being sued. We have, unfortunately, become a very litigious society and the number of cases against Irish doctors has reached almost the same level as those against American doctors. I do not say that people should not have redress if they are damaged or harmed but there has been a huge increase in litigation against doctors, hence the huge rise in medical indemnity insurance.

This Bill applies to doctors in private practice. It is very important that evidence be provided that one has insurance because it is important to a patient who is damaged that he or she has some financial redress to compensate for it. The medical profession is highly regulated and the Medical Council is a very powerful body with many doctors, myself included, trying to keep ourselves out of its clutches, if that is not too strong a way of putting it. It is a very strict body and there is a great incentive for doctors to have medical indemnity insurance and to practise in a proper and safe manner. The ethos of the profession is primum non nocerewhich means, "First, do no harm". Medical mishaps do happen, however. A medical mishap is not akin to negligence and we are processing a new system of voluntary open disclosure in which, if a medical mishap occurs, the patient or the relatives of that patient are informed in a timely manner. Many cases of medical negligence may easily be resolved by an admission that something happened, with an explanation and a commitment that systems will be put in place to prevent the error happening in the future. Many people are happy with an explanation of what went wrong. That is in no way admitting that one has been negligent but it involves an admission that an error has happened. This is very important for the medical profession and I hope the relevant legislation for it passes through the Houses in the not-too-distant future. We have already discussed it in the Joint Committee on Health and we will do so again next Thursday. Medical indemnity insurance is primarily there to protect the patient and to compensate for any error.

Shannondoc was brought up this evening, though it does not directly address the Bill. It is an out-of-hours general practitioner service for patients and is one of a number of co-operatives which are beginning to feel the medical manpower deficit. A huge problem is coming down the road in respect of medical manpower, particularly in the GP area. Some 33% of GPs are over the age of 55, which will mean 900 GPs will retire in the next ten years while the number of GPs who have qualified from medical schools and training schemes are not sufficient to replace them. Many of them look at the contracts in the Irish health system, which have applied over the past 44 years, and will not be taking them up. Many newly qualified GPs are working as locums but will not take up a contract and jobs are coming up for which there are no applicants. This is a huge problem that needs to be addressed on a number of levels. The GP contract needs to be a flexible contract which offers part-time work, job sharing and salaried positions which will attract GPs to work, maybe not for a lifetime but for three or five years in rural Ireland. Rural communities deserve a service as much as communities in urban areas and the new GP contract is key to solving the problems with Shannondoc and the many other co-operatives around Ireland which are suffering from the same problems. The main problem is a lack of GPs in rural Ireland. The number of GPs working in the mid-western health board may not have fallen but most of the GPs are migrating towards urban centres, leaving rural practices without a doctor and out-of-hours services struggling to meet the demand.

Another problem is that the gaps that have been left in rural general practice have been filled by locums from outside Ireland, such as from South Africa and Australia, and their conditions of employment have changed substantially in recent years with the application of VAT to their services and immigration laws. They are required to come and work here for 90 days and then leave for 30 days, before coming back for 90 days and having to leave yet again for 30 days. No locum is going to do that because he can go to any country in the western world and work in much better conditions. The fundamental problem is in attracting GPs to rural areas. To say that the GPs who are still standing, and working, in rural Ireland are not stepping up to the plate is quite erroneous. It has been determined that a rota of one in ten is the lowest safe rota for a GP. That involves a GP working six and a half weeks per year in overtime, out-of-hours work. When one considers that there are professionals who have gone on strike because they have been asked to work 33 hours extra a year, the fact that GPs are expected to work in excess of 6.5 weeks' overtime per year puts the problem in context. We are forcing our young GPs out of the country and what is happening in Shannondoc is going to happen right across the country. It is a national issue, not just a local one.

I commend this Bill to the House. It is essential and it has my support.

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