Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I welcome the opportunity to speak. This is a deal that was done two weeks ago, so it is unfortunate that I did not have more detail in advance of the debate. I hope in his concluding remarks that the Minister will commit to a longer debate once we have had the opportunity to digest the contents of the agreement.

We all know the benefits of primary care. It is a low cost, local service. It is good at delivering preventative, quality care much faster and closer to home than alternatives. I wish to pay tribute not only to those on the union side who negotiated the agreement but also to the officials in the Minister's Department. From experience, I know that much work and many man and woman hours go into getting things like this over the line. The Minister gets to make the announcement but the people in the background do a fair amount of the work and that should be acknowledged.

I am not looking at a new GP contract, however, but merely a revision of the existing contract. We are here to talk about the GP contract negotiations but when will we see a new comprehensive GP contract fit for the 21st century and agreeable to all doctors working in general practice? Some of the areas under discussion in relation to improvements to the current contract and the possible inclusion of the chronic disease management will be welcomed. We wholly welcome that approach which makes complete sense. It is regrettable it was not done earlier but we welcome its inclusion now. However, we must acknowledge that the health service has fallen down in the area of chronic disease management. Far too much takes place in hospital and not enough in GP surgeries. It will take a huge effort on the part of general practitioners and they will need support to ensure that they can deliver. To that end, there must be extensive and ongoing engagement with general practitioners and their representatives to ensure that the chronic disease management section is rolled out and that it is done in a way that benefits patients and enhances primary care.

If I missed it, I apologise, but something which seems absent from the agreement is a women's health programme. The Government's failure to include a substantial women's health programme is regrettable. Much more could have been done to restore the trust of women in our health service and, more importantly, to improve health outcomes for women. In spite of improvements in health service provision for women, we see an area where inequalities are stark. I do not need to tell the Minister that if a woman has the money to pay, she can get the results of her smear test back in a couple of weeks, however if she is unfortunate enough to be a public patient, she will wait for 33 weeks. The Government's failure to fully resource and implement the maternity strategy represents a lack of urgency around issues of women's health.

While I am on the subject, where is the legislation on exclusion zones? All the marvellous GPs in the world will make no difference if women are intimidated on the doorsteps of general practices. When I asked the Taoiseach this morning if he had any idea when this legislation would be available, he said he did not know. That did not fill me with confidence. Maybe the Minister can answer that.

This is the revision of the old contract. Any new contract must look at the area of nursing homes and the provision of GP services to residential care facilities. It is a very pressing matter which has been raised with myself and, no doubt, others. It is not something that is going to go away, if anything the need for it will become even more pressing. This essential service needs to be enhanced. It is provided in many nursing homes on an ad hoc basis. Sometimes it is provided by the grace of the general practitioner, usually related to a personal relationship between the staff and the nursing home, and that is not good enough.

I will get on my hobby horse for a moment as there is no mention of additional physical infrastructure. For instance, in Balbriggan, in my constituency, there is a beautiful primary care centre. It is absolutely gorgeous and it is stunning but all it is a glorified GP surgery.

There are no scanners or diagnostic equipment in the centre. I put a parliamentary question to the Minister and the response I received is that he is not considering enhancing the equipment or the facilities available in Balbriggan at this time. That is contrary to what his colleagues say in the constituency but it chimes true with me because we see no evidence of any plans in the pipeline.

Finally, there is a real need to look at the issue of salaried GPs. Directly employing GPs will allow doctors to be doctors and they will not have to worry about renting, being employers or any of that. We need to examine how the dual model will work. The small business model has worked well - I do not dispute that - but I believe that directly-employed, salaried GPs have a role to play. There is space for a dual model. When we have our longer and more in-depth debate, hopefully we will be able to tease out those issues.

See this speech in context