Michael Harty (Clare, Independent) | Oireachtas source

The process of unwinding FEMPI for professional fees and other payments reduced during austerity years will not commence until 2019 and only then in return for contractual and structural reform, together with productivity and service improvement in line with Government policy. In the health sector this applies to general practitioners, GPs, and pharmacists. This is neither an orderly nor a timely unwinding of FEMPI in respect of GP and pharmacy fees. In that regard the Minister for Health, Deputy Harris, intends to undertake a process of engagement with relevant representative bodies during 2018 prior to starting the unwinding of FEMPI for GPs and pharmacists in 2019, which may not affect their fees and payments until 2020. This is entirely unacceptable. There is a clear pathway for salaried public servants but not for contract holders such as GPs and pharmacists. Additionally, the setting and varying of fees for contract holders who were subject to reductions under FEMPI will enshrine FEMPI-style legislation in an alternative statute. This is also unacceptable. Thus FEMPI-style legislation will remain on the Statute Book ad infinitum.

Varying the fees can be done by ministerial order, with the consent of the Minister for Public Expenditure and Reform, based on affordability and value for money, supposedly to protect the taxpayer through fluctuations in our economic cycle. Such reduction in fees can be introduced in the future, following consultation but without negotiation with the contractors involved. Any restoration of these future reductions will have to go through the same tortuous process we are belatedly going through at present. GPs and pharmacists have been subjected to horrendous FEMPI reductions and the unwinding of FEMPI is now being done in a disorderly manner and is putting pressure on those professionals.

No GP could plan his or her future on the basis that his or her practice income could be reduced by the Minister of the day as he or she sees fit. Any unwinding of FEMPI for GPs will not commence until 2019 or most likely 2020. This is completely unacceptable.. GPs were disproportionately affected by FEMPI as the cuts were applied to the gross public turnover of the practice fee, which included all the expenses incurred in running a practice. The cuts were very deep: 38% reduction in the fees paid to a GP to run the practice. This has had a crippling effect on general practice as a discipline and as a career option for young GPs. They are not entering the profession and the principal reason for that is the disproportionate application of FEMPI to GP fees.

GPs have already delivered productivity and to ask them to increase productivity in connection with the unwinding of FEMPI is completely unacceptable. They have delivered this productivity by increased workload and delivering complex care while taking on greater responsibility for chronic care which is now being shifted from the hospital service to the community. GPs are looking after 50% more patients with medical cards than they did when the FEMPI cuts were introduced. The amount of work now expected of general practice has reached saturation point, due to transfer of care from hospital to primary care and the complex needs of an ageing population being looked after in the community. Productivity also has been increased because we are looking after patients who should be looked after in secondary care.

The "Prime Time" programme last week demonstrated the difficulties of public patients accessing secondary services, which results in increased GP visits and increased responsibility in looking after these patients in primary care while they wait to access necessary secondary care. GPs who were disproportionately affected by FEMPI are now being additionally disadvantaged by having FEMPI unwound on the long finger and having unacceptable conditions applied to the restoration process by tying its unwinding to contract negotiations. The Sláintecare report proposed a decisive shift towards primary care and social care led by general practice. This will require a significant increase in GP numbers if entitlement to universal primary care is to be introduced over the next few years. Young GPs will not sign up to a contract based on the existing financial model that exists under the present contract and the FEMPI arrangements, which are hobbling general practice.

This model of a contract operating 24 hours a day, seven days a week and 365 days a year in which the GP pays for everything and takes full financial responsibility is broken. The method of partially unwinding FEMPI enshrined in this Bill will ensure that not only will young GPs continue emigrate but those who are away definitely will not return. Our aging population of GPs will retire long before they would wish. More than 600 GPs are over the age of 60, that is one quarter of the workforce, and will retire in less than a decade. This uncontrolled and unacceptable unwinding of FEMPI will cripple our already crumbling general practice network. This at a time when the HSE predicts that we will face a shortfall of 2,000 GPs by 2025. New services cannot be funded by FEMPI restoration, as the financial model is now unsustainable and broken. The Minister cannot expect GPs to accept the unwinding of FEMPI for contractual services which they already give and productivity they already provide.

In Ireland, 3.5% of health expenditure is spent on general practice. In the UK the percentage is 8.1% and it proposes to move to 11%. Ireland is losing its GPs to countries which have better resources and better health services where they have better job satisfaction, career prospects, training opportunities and working conditions. One arm of the State is proposing that we expand GP care, following the Sláintecare report, while another arm is making it financially impossible for GPs to continue in practice or to enter the service.

This Bill gives effect to the public service stability agreement. The three teachers' unions have voted against this agreement because it failed to deal adequately with new entrant pay. This Bill proposes significant sanction for members of unions who have not signed up to this agreement, involving the removal of their increments and the maintenance of higher pension contributions at the level of the current pension levy. These sanctions should be removed by way of amendment to the Bill in order that inequality in pay is not compounded.

Thus, sections 21 and 33 should be removed from the Bill. The removal of these sections will not interfere with the implementation of the agreement for those who have accepted the public service stability agreement. This is driving our young graduates out of the country. It is driving them into financial difficulties with housing, jobs and job security. It is really unacceptable that professionals should be subject to this FEMPI unwinding, which makes no sense whatsoever. Certainly as it relates to general practice, if this is how the Government will unwind FEMPI, it will finally cripple general practice.

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