Mick Wallace (Wexford, Independent) | Oireachtas source

The current GP contract is 47 years old. There have been no major structural changes to it in that time, bar a little tinkering.

General practice in Ireland receives 3% of the overall health budget and yet general practice in most developed countries receives 10%. This disparity needs to be addressed in Ireland. Research has repeatedly shown that if one spends €1 on investment in general practice, one will save €5 at hospital level. Seven hundred GPs are due to retire in the next five years in Ireland. Some 70% of GP practices outside of Dublin are closed to new patients. Where are these patients supposed to go? Only 20% of GPs are IMO members, 40% are members of the National Association of General Practitioners, NAGP, while 40% are not members of any union. This new contract has been negotiated without the input of the vast majority of GPs or their representative bodies. The vast majority of GPs have still not seen the new GP contract. Only one-in-five GPs have seen the contract via the IMO.

The proposals relating to reversing FEMPI cuts - amounting to €120 million over three and a half years - will not save general practice. The reversal package is grossly underestimated in terms of what is needed according to the GPs to whom I have spoken. The three-and-a-half year timeframe is far too long.

GPs in Wexford are adamant that for general practice to survive in the county and, indeed, nationally, particularly in rural areas, the following need to happen. First, there needs to be serious acceleration in the context of reversing FEMPI. Second, GPs need an optional out-of-hours commitment. Fifteen years ago, the NHS made out-of-hours optional. This agreement was signed by more than 95% of UK GPs. It has been a success, despite initial British Government fears. The sky did not fall in by giving GPs flexibility in terms of working out of hours. It is nuts for there to be 24-7, 365-days-per-year commitments for GPs. This kind of unreasonable burden for GPs is doing nothing to attract young doctors to the practice. Another vital requirement is a new GP contract. GPs need flexible contracts that are family-friendly. That is crucial. Of course, capitation needs to be increased but flexibility must also be built in to the new contract.

The GPs to whom I have spoken are deeply concerned that after all this time waiting for a new contract, what they are actually getting is not really a new contract at all but, rather, a slow, drawn-out reversal of FEMPI. GPs fear that they will be simply returning to a pre-FEMPI state, that they will be back to square one and that they will not have made much progress.

I am only telling the Minister what I am hearing from GPs, I am no expert on medicine.

There is a perception that GPs are rolling in money but, for those on the existing contract, that is far from true. More than 50% of the population has access to free GP care. For example, the fee through the GMS contract for female patients aged 16 to 45 is currently set at €43.79. That fee is per year, not per visit. That is how much Irish GPs are paid for unlimited, 24-hour access, seven days per week, 365 days per year for this group. Ireland is haemorrhaging GPs and cannot attract new people. I spoke to a GP in Wexford town, Dr. Bill Lynch, who had to go to Barcelona in order to try to hire new GPs. A realistic, flexible, indicative staff budget must be agreed. What about sick pay, maternity and annual leave?

I hope that the new contract will clarify the issue of GPs charging for routine blood tests, a practice that is clearly prohibited under the Health Acts. The Minister has repeatedly stated that the GP contractual review will provide clarity on this decades old problem. I am regularly contacted by people who are incorrectly charged for blood tests. I have sympathy with GPs who are so financially squeezed that they are leaving general practice in droves but the situation has, for many patients, created a toxic relationship with some of their GPs. It has caused a significant amount of stress and financial difficulty for patients in Wexford and elsewhere.

Perhaps the Minister can explain why patients I have spoken to must wait for a year and a half to get refunds in respect of charges which never should have been imposed in the first instance. Some people do not even know their rights when it comes to charges or accessing refunds. Even if they do, the inconvenience and delays involved in getting refunds is infuriating for many individuals. If we are not going to enforce the existing legislation and provisions of the existing GMS contract, can we at least have a fit-for-purpose refund scheme? A very obvious solution to this problem would be to actually recognise the workload GPs do and their importance to communities in delivering primary care services and to properly reward them for this service with the kinds of contracts they deserve.

The Minister stated that he recognises that GPs working in rural and socially deprived areas play a particularly important role and that he wishes to assure the House that the Government is committed to ensuring that general practice in such areas remains a sustainable and attractive option for doctors. It is not a sustainable and attractive option for doctors right now so for the Minister to say that he wants it to remain so is playing with language. The majority of GPs I encounter in Wexford indicate that it is not a sustainable and attractive option. Can we make it sustainable and attractive? Failing to do so makes no sense.

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