Alan Kelly (Tipperary, Labour) | Oireachtas source

In fairness, I do not want to rain on the Minister's parade. He has enough issues with which to deal.

I do not know why we are having this debate tonight. It would have been time enough to have it at a later date because the information is only coming through. We are having to analysis it and go through it now. I would like to have had time to talk to many of the GPs who I have worked with over the years to go through some of this.

In fairness, the Minister and his colleagues have put a great deal of effort into this. I respect that. I welcome a significant amount of what is proposed. All the measures relating to doctors, such as the family-friendly measures, etc., will make the profession more appealing to those who want to remain in it. The measures to address the number of GPs who leave the country - a matter not dealt with to date - are all welcome. As somebody who was member of the Government that introduced free GP care for children, I welcome that it is being extended to those under 12. However, this is the outline of a deal. We do not know fully how it will be received or how it will be implemented. For example, on the aspect of extending free GP care to those under 12, there is another negotiation that has to go on and then individual GPs will have to decide whether they will participate or not. The process by which that will happen all needs to be worked out.

I do not have enough time to go into the detail of all the individual issues. Following the process the Minister went through with this, I presume there is an estimate of the real impact what is proposed will have on retaining GPs in this country and also on enticing more to remain in the profession. Is he in a position to put figures on the estimate of the impact it will have in that regard? In other words, how are we to arrest the decline and does the Minister of the type of estimates to which I refer?

I specifically want to discuss GPs in rural Ireland. We have a particular problem in geographically isolated areas. Given that the Government, which does not have long left in office, is intent on implementing Project Ireland 2040, there will be fewer people living in rural areas. As a result, GP contracts in those areas will be less viable. I have no doubt that the Minister will have to resort to a different direct-employee contract for GPs in isolated rural areas. Has that been dealt with? Will that form part of this agreement? Has it been considered? What is the status of that? We must have that. I can categorically guarantee that unless the Minister has that type of contract in certain specific geographical areas, there will not be GPs there. I can tell the Minister that right here. That is the direction in which Ireland is moving; that is the trend. That is where the Government is going with Project Ireland 2040.

Something the Minister cannot throw back of me is ehealth. I speak about this all the time. Few Members have come in here and spoken about this at length as I, coming from that background myself, have done. I read a great deal here about ehealth, e-prescribing and a range of other matters. I actually do not know what these terms mean. Where are they in relation to the public service card? Where are they in relation to the ehealth card? Where are they as regards the data? What will be the process? What infrastructure has to be put in place? What pathways are there for the sharing of information? How will all this work?

I agree with ehealth. Is there a guarantee of consistency? Is there a guarantee that all GPs will participate because when one moves across to such new measures, one must ensure that everyone is on board. One cannot have a situation where some GPs are participating in a new way of doing things and others are not. If one leaves in that scenario, and patients change and GPs change, with different health systems all of that must apply across the board. Can the Minister give us a guarantee in his reply that it will apply across the board? I know by the Minister's demeanour that he is not sure. I would really appreciate knowing. That would be a significant issue.

In the context of health, will analysis of referrals from GPs be supplied into the central system of the HSE? For example, there are serious issues in the mid-west regarding referrals to hospitals. Some GPs practice fantastically not a large amount of referrals. Some others who have a significant amount of referrals do not. I am not saying every area is the same. One is not comparing apples with apples and oranges with oranges. In general, however, there should be some form of trend. I hope that data is being gathered as part of this process as it all would help us.

Without going into the individual components of what we understand to be agreed, there is one final matter about which I am disappointed. I would like to see some emphasis on the GP role in advocacy as regards future screening programmes. If the Minister could stitch that in, I would welcome it. It would not be a major issue. I would take it as a positive if the Minister could go back and look at ensuring that an advocacy role, for all the reasons that we have debated previously in this Chamber, is included in the eventual contract. That would be a welcome development.

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