Michael Harty (Clare, Independent) | Oireachtas source

I thank the Minister for introducing this topic. We have had many conversations about the issue and I welcome the proposed agreement between the IMO, the Department of Health and the HSE which is still under discussion at IMO meetings. I may have an advantage, being an IMO member, in that I have in my possession a document which outlines, in broad brush strokes, what is contained in the agreement.

I welcome the agreement because it will reverse the cuts that were introduced by means of the FEMPI legislation. I also welcome the fact that it starts to integrate chronic care between primary and secondary care, to digitally gather information about population health and hopefully it will start ehealth initiatives, such as e-prescribing, which have tremendous advantages in general practice. This is a reversal of the disproportionate application of FEMPI to general practice. FEMPI made many practices financially unsustainable and led to the disbandment of many practices in urban and rural areas, practices which no longer exist. It has led to the loss of full-time GP services in many areas where practices have been amalgamated with practices in the nearest town. FEMPI has created a vacuum which has allowed to enter general practice commercial entities that may not have the same vocational value as existing general practices. It has also allowed gaps in the system where pop-up GP practices are now appearing in many urban areas which do not supply the same quality of care that established general practices do.

FEMPI has led to the manpower crisis we currently face. Some 70% of practices are not taking on new patients. In many towns and some counties, there are no GPs who are taking on new patients and that is because of the workload that has developed on foot of the manpower crisis. Only 90 GPs under the age of 35 hold the GMS contract and 700 GPs are due to retire over the next decade. There is a real manpower crisis and we need to start training more GPs if we are going to deliver the enhanced services that this agreement proposes and to give free additional care to the first cohort of patients, those under the age of 12. The Minister must understand that under-12s are not the most needy cohort of patients in our community. It is political policy of Fine Gael but healthcare should be delivered to the most needy. That is a policy issue over which we, as GPs, have no influence.

A GP visit card facilitates a free visit to a GP but it does not carry the other services that a full GP card delivers. That is a major fault in only supplying GP visit cards because it disenfranchises people who are expecting to get a full service and who do not.

We need additional GPs to deliver chronic care which is already devolving from our hospitals. This contract copper-fastens what many of us are doing. Some 53% of doctors who left the Medical Council in the past number of years are aged under 35 and many of those are newly-qualified GP trainees who do not see a future for themselves in Ireland. It is in this context that the agreement has been reached. I welcome the agreement because I hope it will reverse some of the trends that I have just mentioned. I hope it will lead to a reversal of the loss of GPs from our general practices and only time will tell.

This is not a new GP contract, it is reform of the existing contract. It appears that a new GP contract is at least four years away, particularly if we are to carry through the reforms outlined in this document. Nevertheless, I welcome the restoration of funding and it is important that it is front-loaded. Some 50% of the restoration of funding will come on 1 July and that is important because it will give hope to practices which are struggling financially. It will allow practices to employ staff, I hope, and also to supply a wider range of services.

The agreement is a tangible first step in implementing Sláintecare. It is the very first tangible step that patients will recognise that Sláintecare is beginning to be rolled out. It reorients the health service back towards primary care. It places general practice at the centre of health reform and starts to develop chronic disease management in general practice but this will only pay dividends if that is integrated with our hospital service. It must be an integration of chronic care between primary and secondary care to get the maximum value.

It is very important that GPs' co-operation with community health networks is from the bottom up and not the top down. GPs need to be involved in organising, financing and making decisions about how resources are dispersed throughout their population in their community health network and the advisory council that has been set up and the implementation office, under Ms Laura Magahy, will be crucially important in ensuring we get this correct. It should not be a diktat but should come, rather, from the bottom up, where GPs are equal to all the other stakeholders in that process.

I welcome the roll-out of ehealth over the next four years. In particular, e-prescribing is the initiative on which the Government should concentrate.

There are many points I would like to discuss but the deprivation fund set up for, most likely, inner city practices is extremely important. The Minister has probably heard from Deep End Ireland how critically important health needs in deprived areas are and how they are not funded properly. This fund is innovative and I welcome it.

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