Niall Collins (Limerick County, Fianna Fail) | Oireachtas source

I am delivering our party's contribution on behalf of my colleague, Deputy Calleary, who cannot be here. Fianna Fáil has long called for the unwinding of the FEMPI legislation in a fiscally responsible manner. We want to see a fair deal for public sector workers, particularly for low and middle-income earners. It is imperative that we have strong and sustainable public services and that industrial unrest is avoided.

FEMPI must be unwound in a responsible and sustainable way that treats public servants fairly and ensures the provision of vital public services to those who need them. Reversing FEMPI immediately will do nothing to solve problems surrounding pay inequality and will only succeed in restoring pay to the higher-paid civil servants. Industrial unrest will ultimately cost everyone dearly.

The Government and trade unions came to an agreement earlier this month. However, key challenges remain. Each union and association must now consider the proposals and then put them out to ballot of its members. Time must now be given for the unions and associations to vote and the process should be allowed to proceed.

Despite the agreement earlier this month, key issues remain to be resolved. The agreement is vague to say the least on pay equalisation. Workers who joined after 2013 will still be paid less than their colleagues who took up their posts before then, despite doing the exact same job. The agreement states that any solution to this issue must not give rise to implications for the fiscal envelope of the agreement. It is difficult to see how this issue will be resolved in such circumstances. This is a major issue and the Government must outline in more detail how it intends to deal with it.

Staff retention and recruitment is another key issue affecting the public sector, which the agreement fails to address fully. In areas like nursing and the Defence Forces numbers have been falling to critically low levels. This not only affects the services themselves but also the conditions of existing employees. The agreement is also vague on retired public servants. In particular it is not clear how the difference between retirees who retired before 2012 and after 2012 will be addressed. I ask the Minister when summing up to respond to some of these issues relating to vagueness.

As we are discussing FEMPI, I take the opportunity to quote from a letter that I and other Oireachtas Members received from a GP in a rural practice, which happens to be in my constituency. It relates to FEMPI and the broader health service. It states:

As you may be aware the all-party Oireachtas Committee on the future of Healthcare/Slaintecare Reportrecommendations are up for debate in the Dáil before the summer recess. We GPs would greatly appreciate your support in bringing the following to the attention of your colleagues before and/or during the debate.

1. Since the implementation of the free GP care for children under 6, attendance of such children at my practice has increased by 40%. This increase has also been reflected in the local out-of hours service, Shannondoc. Indeed I have several children under 2 attending me who have attended 30+ times in the first year of life, outside of vaccinations and developmental checks. This illustrates that people do not appreciate that which is free and instead overuse it. This has resulted in elderly genuinely unwell people being unable to access the GP when they genuinely need to be seen which has increased the number of people needing admission to hospital as they are seen later in their illness.

2. The new Accident and Emergency department in University Hospital Limerick opened on Monday 29th May (2 years late). I happened to be attending for a sexual assault and decided to have a look around. The new area is 3 times the size of the existing A&E and was already, 19 hours after opening, at 3am, full of trolleys. This is partly because of the problem detailed above and partly due to a lack of beds in the hospital itself.

3. There are 46 GPs in our West Limerick Shannondoc area. Of those 46, at least 11 will be retiring in the next 5 years. There are NO GPs to replace them. We currently struggle to find locums to cover holidays and have zero chance of finding anyone in case of illness or other emergency. My partner retired 2 years ago and I have been unable to find an assistant. This is for the following reasons:

- Young GPs now qualifying do not see Ireland as a viable prospect to run a business and are emigrating in their droves.

- Those who stay can pick and choose the jobs they want as there is such a shortage

- Due to the demand they can afford to work in cities where they have the back-up of a hospital nearby, where they don't have to do out of hours work or house calls, where they can work as employees with all of the rights and none of the responsibilities of running a business.

- Rural GP is not attractive to them.

General practice needs your help. Put simply, if this continues, when you are older and need care, there will be no doctors to care for you.

I am quoting this letter because it goes on to mention FEMPI. It states:

One of the first things that needs to be addressed (now that it is being addressed with all other parties affected) is the reversal of the FEMPI cuts. GP [general practice] was hit with 38% cut in funding over 3 years which was greater than any other group. That cut in funding was not to our wages but to the gross money coming into our surgeries out of which we have to pay mortgages/rent, staff, professional indemnity and for all the courses and conferences that are obligatory for us to maintain our medical registration.

At the same time as the FEMPI cuts, many more patients became eligible for medical cards due to unemployment, then you had the under-6 card and the over-70 [medical] card. This dramatically cut our private income also.

We cannot continue to provide the level of service that we have done for the last 40 years, plus take on all of the extra work that Slaintecare has suggested without funding and more doctors, and we will not get more doctors without the funding to make it attractive for them to stay.

The other thing that needs to be addressed with urgency is a new contract for GMS GPs. Our contract is over 40 years old and is completely unfit for purpose. Medicine and demand for care has changed dramatically in that 40 years and the new contract needs to reflect this. All parties affected, IMO, NAGP etc. need to be at the table for that negotiation (not consultation) process. We were supposed to have a new contract by July 2015, 2 years later, there appears to have been little progress.

Thirdly funding in general needs to be increased to Primary Care. If we are to appropriately manage chronic illness (which incidentally is not part of our current contract), we need more staff and more money to do so, to purchase equipment and, hopefully if they can be found, hire extra doctors to help. If hospitals are to have any hope of lessening the trolley crisis, we need to increase funding to home help, to carers and to nursing homes so that vulnerable people have somewhere safe to go on discharge. If we are to keep people out of hospitals, we need more access to physiotherapy ... to occupational therapy and to respite care. With an elderly population there is increased demand for house calls for which there is NO remuneration during surgery hours and it makes it financially unviable to do them. Multiple minor surgeries and other procedures such as contraception are carried out in GP [general practice] and cost up to 10 times less when done in GP as opposed to in hospital but we don't have the time ... or the funds to perform them.

Lastly, with respect to "free" healthcare for all, I used to be in favour. But having seen the effects of the Under 6 card, I can no longer support it. I believe, as do most of my colleagues, that there should be a maximum number of "free" visits and/or a small charge for each visit so that people only attend when really necessary.

General practitioners are at the heart of the healthcare system, completing over 25 million consultations every year (95% of patient contact). The Irish public values their family doctor and wants their GP to be at the heart of their local community. However, we are at a crossroads - unless the recommendations above are implemented, we will never fix our healthcare system. This is our chance, and your chance, to help do that.

That is correspondence I and other Deputies received indicating one rural GP's views of the situation. I wanted to put it on the record of the House because there is a FEMPI angle to it.

I reiterate the Fianna Fáil position on FEMPI.

We have long called for the unwinding of FEMPI but we recognise that it is not simple. There are parameters within which that has to be done and it must also be done in a responsible manner and one which is sustainable.

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