Charlie McConalogue (Donegal North East, Fianna Fail)
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I thank the Ceann Comhairle for putting this matter on the agenda and ensuring it will be addressed by the Minister. This is a very important issue to County Donegal which has been leading to some concern among people over the past number of days. I have put this on the agenda to give the Minister for Health and his Department the opportunity to reassure people in County Donegal that there is no threat to the continuation of NoWDOC services at the four centres in County Donegal from which it is currently provided and that the service will be maintained at its current level, thus ensuring people have 24 hour access to a GP within a reasonable distance from their homes.

When people contact NoWDOC or a GP in the middle of the night or outside normal office hours, it is not because they have something wrong with them which can wait until the next day; it is because they have a concern in regard to their health that often is an emergency which needs to be addressed by a doctor immediately. There has been some concern, and much coverage in newspapers, in the past week in regard the potential closure of three of the outreach centres in the county, with the GP service from midnight to 8 a.m. being provided through Letterkenny alone. Indeed, there is a rumour that perhaps only one car will be provided.

As we can all understand, that is very concerning and it must be knocked on the head immediately by the Minister and the HSE so that we can all be sure that service will continue to be provided. We had a meeting last Friday, which all Oireachtas Member from the county attended, with HSE management and which was very useful. We made it very clear at that meeting that this must be addressed immediately. HSE management indicated that it does not have any plans to change the service but in written correspondence from the HSE, we have not received absolute clarity that is the position of the Department of Health and the HSE.

This is a red line issue and it is not up for negotiation. The Minister has the opportunity to reassure people and I ask that the Minister of State takes this opportunity to do so.

Róisín Shortall (Dublin North West, Labour)
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I thank the Deputy for raising this issue. The provision of general practitioner, GP, out-of-hours co-operatives throughout the country is an essential part of our health service and we fully support that policy in terms of strengthening primary care services and ensuring that, as far as possible, care needs are met in the primary care setting. Out-of-hours co-operatives are now in place in all HSE areas, providing coverage in all or in part of all counties. The service can be accessed through a single lo-call telephone number in each region and caters for both public and private patients.

Out-of-hours co-operatives allow GPs to manage the provision of urgently needed care for their patients while their surgeries are closed in the evenings, at weekends and on public holidays. The co-ops also afford GPs reasonable off-duty arrangements. Under the GMS contract, GPs have a responsibility to enable contact to be made with them, or a locum, for emergencies outside normal practice hours. It is a matter for the GPs how they arrange this cover.

The NoWDOC service, which is now ten years in existence, is a co-operative structure between GPs and the Health Service Executive to provide urgent GP services to patients who may require them in the out-of-hours periods, that is, evenings, nights and weekends. It covers Donegal, south Leitrim and north Roscommon, with 98 full-time GPs participating in the service. The budget for the NoWDOC service last year was €3.168 million, while the national budget for GP out-of-hours services last year was almost €100 million. More than 57,000 people contacted the NoWDOC GP out-of-hours service last year and, of these, more than 36,000 were treated at the GP out-of-hours treatment centre or received a home visit. Some 33,600 people contacted the NoWDOC service in the first six months of this year.

In terms of the partnership that exists between the GPs and the HSE, the HSE provides the infrastructure for the service, including support staff, such as drivers, receptionists, nursing staff and so on. The GPs provide the cover for the various doctor rotas for the out-of-hours periods. All calls to the service are handled and triaged in the call centre in Letterkenny and treatment centre visits are arranged by appointment only.

The HSE west is currently reviewing the NoWDOC services. This follows directly from the recommendations of the national review of GP out-of-hours services which was carried out and published in 2010. The HSE, in implementing the recommendations of the national review, is looking at all operational activity, including staff who are employed by the HSE, to ensure that safe and efficient services can be maintained in the current difficult financial environment. This review to date has resulted in the HSE submitting proposals to the trade unions regarding the redeployment of receptionist staff and the expansion of the drivers' role under the provisions of the public service agreement 2010-2014. These discussions are ongoing and will be concluded in the coming weeks.

The proposed changes reflect the staffing models that operate elsewhere throughout the country and will provide for the continuity of safe patient care at each of the centres which are affected in this proposal, that is, Derrybeg, Carndonagh, Mountcharles and Carrick-on-Shannon.

At the annual general meeting of NoWDOC Limited, the GP members of NoWDOC passed a motion to form a sub-committee to examine viable options for the provision of GP cover for red eye periods and submit proposals to the HSE to outline how such cover might be provided more efficiently without compromising patient safety.

The outcome of the GPs review has not yet been finalised and no proposals have been submitted to the HSE for consideration. While changes to service delivery arrangements may be proposed in the future, the issue of curtailing or reducing services has not featured in any discussions to date. Again, I thank the Deputy for raising this matter.

Peter Mathews (Dublin South, Fine Gael)
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I must confess to my unfamiliarity with the term "NoWDOC".

Charlie McConalogue (Donegal North East, Fianna Fail)
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I thank the Minister of State for her reply. I note she said that no changes are proposed to service delivery arrangements. That, in itself, is welcome. However, it is important that it is made absolutely clear to the Department of Health and the HSE, in the future and in these more difficult financial times, that the provision of GP services at centres, which are local to people throughout County Donegal and the rest of the country, are a red line issue and not up for negotiation. No one has any problem with GPs and the HSE talking to each other. However, the key point which has not been made clearly enough today or by the HSE is that from a Department of Health and a HSE point of view the continuation of GP services in a local area and within a reasonable distance from people homes is absolutely critical and will be at the core of any discussions so that people can be assured there is no threat to local GP out-of-hours services, whether red eye or pre-midnight services. That is critical and I ask the Minister of State to be clear in that assurance.

Will the Minister of State comment on the current restriction that applies to NoWDOC cars in that they are restricted to the speed limits even when they are on emergency calls? This does not make sense. Many roads in County Donegal have 80 km/h speed limits because they are not national roads. Only a few weeks ago, a GP car responding to a call in the Carndonagh area was fined and received two penalty points. That needs to be addressed. If someone in County Donegal or elsewhere is waiting on an emergency GP service, one does not want that GP stuck doing 30 mph within a 30 mph zone or 80 km/h within a 80 km/h. One wants the GP to put on the emergency lights and get to the patient as quickly and as safely as possible. Will the Minister of State assure the House that people will continue to have access to GP services within their local areas?

Róisín Shortall (Dublin North West, Labour)
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I assure the Deputy that the Government is committed to the development of primary care services and GP care throughout the country. This is one reason for the clear commitment in the programme for Government to provide for free GP care during the Government's lifetime. It is also one of the reasons we will start debating a Bill this evening on opening up access to the General Medical Services, GMS, scheme. I am working on expanding the number of GP training places, as we want 90% of health care activity to occur at primary care level. During the coming months and years, we will roll out reforms to enable this health activity to take place as close as possible to patients, which is where people want to be treated. It makes sense.

Ensuring access to out-of-hours GP care is part and parcel of the reforms, as it makes sense from the patients' point of view to deal with people's conditions early and before they become serious enough to warrant a trip to hospital. This approach also takes pressure off the hospitals. We will discuss this point during Private Members' business.

I pay tribute to the work of NoWDOC in providing a range of services in the north west during the past ten years. However, it is the contractual responsibility of GPs to ensure out-of-hours cover is provided. While the HSE provides the infrastructure and support services, for example, receptionists, drivers and so on, it is primarily the responsibility of the GPs to ensure that they adhere to the terms of their contracts. The HSE is waiting for the proposals to be returned by the GPs involved to determine the arrangements it will make to ensure the existing cover in the north west is maintained.

I am not in a position to respond on the issue of speed limits, but I will take it on board and determine what can be done.