Thursday, 11 November 2010
General Practitioner Services
Question 6: To ask the Minister for Health and Children her plans to make it easier for new general practitioners to provide services for patients who hold a medical card; and if she will make a statement on the matter. [41864/10]
I strongly support the view that access to General Medical Services, GMS, contracts should be opened up to all qualified and vocationally trained GPs who meet general suitability criteria. The Irish Medical Organisation, the HSE and my Department are parties to the terms of the GMS contract. A consultation group representing all parties to the contract have been reviewing the provisions relating to entry to the GMS scheme. Considerable progress has been made in this regard. An interim arrangement which applied up to 31 March 2010 allowed appropriately qualified and trained GPs to apply for access to the GMS scheme to provide a service to specific categories of patients such as those who become eligible for a medical card under the Health Act 2008 after 1 October 2009. A total of 178 GPs have been deemed eligible under this arrangement and a further 66 applicants are awaiting a decision pending the supply of further documentation or further clarification.
A further initiative which allowed a number of GPs who commenced working under the GP visit card scheme in 2005 to be allowed take on full GMS patients in 2010 was brought forward by one year and implemented from 1 July 2009. Approximately 50 GPs benefited from this measure. In addition, work is ongoing to identify a mechanism to up-skill long-term locums or assistants who are not currently eligible for GMS contracts. My Department and the HSE continue to explore further options to make it easier for new general practitioners to provide services for patients who hold a medical card.
I thank the Minister for her reply. That all sounds very good and progressive but the Competition Authority notes that before any decision is made regarding a new contract in an area, due regard must be given to the viability of existing GP practices. The marking system used for selecting who will be given a contract gives more points to GPs who already hold contracts. As the authority points out, this is not good for either competition, the patient or the service. Everyone will agree that having competition around the corner from another GP probably forces people to up-skill. Newly qualified GPs are being forced into practice in existing areas. It needs to be opened up.
I refer to a report by Dr. Ronan Boland whom I know quite well. He stated that criticism of the decision on payment agreements for GPs was no longer valid. He said that as part of the Croke Park deal, the most recent public service agreement, the Government said discussions would take place with the Irish Medical Organisation regarding commitments to make appropriate changes to the Competition Act 2002 to enable the IMO to represent its members in negotiations. I welcome this proposal but where does this leave the poor old Irish Pharmacy Union?
I agree with the Deputy's point about the marking system. Changes in that marking system are at an advanced stage in order that preference is not given to the individuals as she suggested, and that is only fair. I have been informed there could be 400 or 500 GPs. The data suggest it is probably close to 500. There are a total of 2,600 GPs in active practice, 300 doctors are working in a locum capacity and 2,100 have a GMS contract. This means there is a gap of 500 GPs and I want those individuals to have access to a GMS contract. There is an agreement between the Department of Health and Children, the IMO and the HSE - previously the health boards - which precludes that. I have sought the advice of the Attorney General. Under the Croke Park agreement we hope to be able to reach agreement on some of these issues. This would involve the change of the contract in this case.
The Competition Act is a matter for my colleague, the Minister for Enterprise, Trade and Innovation, Deputy Batt O'Keeffe. Any changes to competition law are a matter for him and not for my Department.
I welcome the Minister's indication that she hopes for a situation of universal access for GPs to the General Medical Services scheme. That is as it should be and I fully concur with Deputy Lynch's argument. As a backdrop, is there not also the issue of the real shortage of GPs per head of population? When a comparison is made between Ireland and Germany, it is noted that Germany has twice as many GPs per 100,000 of the population. In France the number is in excess of three times as many. The number of GPs in Ireland is 52 per 100,000 of the population and up to 164 GPs per 100,000 of the population in France. Is there not a major need to increase places to allow for a greater throughput of GPs into the system? In 2001, some 600 primary care units were promised but only 112 have been realised and there is a real need. Will the Minister comment on this aspect of the question posed?
I welcome the Deputy's comments regarding opening up the GMS scheme to all GPs. He is correct that there is a shortage of GPs. We have increased the number of training places this year from 120 to 157. We have also greatly increased the number of medical students. The big challenge will be to keep those students of medicine in Ireland or in medicine anywhere because a fair number of medical students do not subsequently stay in medicine. A large number also leave the country, some for reasons of training and others on a more permanent basis.
We have a number of challenges such as opening up access. It is not fair that not all GPs have access to the GMS scheme. The terms of the GMS contract require the parties to agree and to give notice of an intention to break the contract. I have sought the advice of the Attorney General because contracts cannot go against the law. A number of GPs do not have access to the GMS practice and are very agitated, and rightly so. Those issues need to be addressed in the interest of fairness and equity but also in the interests of having wider access to general practitioners with a GMS contract.
The primary care teams involve individuals working together in a different way. I accept there are deficits in the system. Even if all health professionals are working in the community and working better together on a team basis, that in itself has significant benefits for patients.
I concur with other speakers and I encourage the Minister to open up the GMS scheme to suitably qualified GPs. I echo the point made by Deputy Ó Caoláin about the shortage of GPs in the country. Certain areas such as Tallaght have no GP practice. If the contract is to be changed, I appeal to the Minister to ensure that in the opening of up the GMS scheme to GPs, they do not all end up in Grafton Street with no one out in Tallaght. The message is clear that we need to have a structure to encourage GPs into areas where they are needed to provide a service.
The change must be made in the first instance. Anyone who is qualified should have access to a GMS contract if they have the necessary qualifications and vocational training. If this is the case there should be no barrier. It is in the interests of the HSE to provide supports for GPs based on volume of patients. It would not be acceptable for a small practice to be given the same level of support as a large practice with a large number of patients, especially in disadvantaged areas. This may not appeal to everyone but I favour distorting the way we pay GPs to favour those operating in more disadvantaged areas where the challenges are greater. This is the practice in other countries. In the context of any new contracts, we need to examine this policy.