Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health the consultation his Department has undertaken with general practitioners in relation to the proposed introduction of free general practitioner care for under fives; and if he will make a statement on the matter. [40236/13]

Alex White (Dublin South, Labour)
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The Government is committed to introducing, on a phased basis, a universal general practitioner, GP, service without fees within its term of office, as set out in the programme for Government and the future health strategy framework. It is a matter for the Government to determine policy in this area. There has been no Government decision at this stage on the details of the roll-out of a universal GP service, such as a proposal for a specific age cohort. When the Government has taken a policy decision in this area, I will engage with all relevant stakeholders, as appropriate, on the implementation and administrative arrangements.

The introduction of a universal GP service constitutes a fundamental element in the Government's health reform programme. The current Government is the first in the history of the State to have committed itself to implementing a universal GP service for the entire population. A well functioning health system should provide equal access to health care for its patients on the basis of health needs, rather than ability to pay. The principles of universality and equity of access mean that all residents in Ireland should be entitled to access a GP service that is free at the point of use. Universal access to GP care will facilitate the early identification of medical conditions, reducing the burden of illness, greater collaboration in the provision of primary care services, improved management of chronic diseases and will improve the delivery of essential health promotion and protection measures.

It has become clear that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition, as outlined initially in the programme for Government, is likely to be overly complex and bureaucratic. Relatively complex primary legislation and detailed regulations would be required to provide a GP service to persons on the basis of their having a particular illness. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

The Government is firmly committed to introducing a universal GP service within its term of office. The Cabinet committee on health has discussed the issues relating to the roll-out of the universal GP service and has agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees.

Additional information not given on the floor of the House

As part of this work, consideration is being given to the approaches, timing and financial implications of the phased implementation of this universal primary care health service. A range of options are under consideration with a view to bringing developed proposals to the Government shortly.

Billy Kelleher (Cork North Central, Fianna Fail)
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We have received no further information as to what is happening with regard to the roll-out of universal GP care. We were given a commitment that an announcement would be made at some stage after the summer regarding what would replace the original commitments in respect of long-term illness in the roll-out of GP care. What I find amazing is that it is two years into the Government's term of office and we are still waiting for a formal policy decision on how it will implement GP care and the pathway to universality by March 2016, which is when the Government's term ends. Even though the Government has not yet made a decision on how it expects to implement this proposal, it should be discussing how the roll-out would work with the GPs. The programme for Government states that there will be universality by the end of the Government's term of office. In that context, it is incredible that there have not been discussions with the GPs. I believe it is a delaying tactic, so the Government can say that it must now enter into discussions with GPs, which will take a protracted period of time as well. The Government could be doing this already in advance.

Alex White (Dublin South, Labour)
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I assure Deputy Kelleher there is no question of a delaying tactic in this regard. In fact, I discussed this matter with the Minister for Health as recently as this afternoon. We are actively considering this question in terms of the approaches, the timing and the financial implications of the phased implementation of the universal primary care health service. As I said previously, it must be seen in the context of the broader reform programme, including the roll-out and implementation of universal health insurance. The two go hand in hand. A range of options is under consideration with a view to bringing developed proposals to the Government shortly. We indicated before the summer that we would make announcements after the summer, as Deputy Kelleher said. At the risk of being facetious, it is still after the summer. We are working very actively on this question.

With regard to the Deputy's question about the GPs, we will discuss this matter with them. However, the Government will make the decisions. All Governments must operate on that basis. The policy decisions are made by the Government but the implementation and the roll-out will, of course, be the subject of discussions.

Billy Kelleher (Cork North Central, Fianna Fail)
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Governments make decisions but the problem is that this Government has not made a decision. The only decision it has made is one of prevarication. It is now two and a half years down the road in respect of a major plank in this Government's commitment to universality of primary care by the end of the Government's term of office.

Alex White (Dublin South, Labour)
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Will the Deputy support us on it?

Billy Kelleher (Cork North Central, Fianna Fail)
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We would certainly like to see the proposals at some stage. In the broader context, it is incredible that the Minister has not sat down and discussed how the roll-out would work.

Even if the policy decision relates to long-term illness or if the cohort involved is based on age, the reality is that the people who will be responsible for implementing the actual policy will be GPs. What will happen is that the Government will hopefully make a decision at some stage and it will then enter into major discussions with GPs during the following six to 12 months in the interests of having that decision implemented. We are aware of one fact, namely, that the Government is committed to introducing free GP care for everybody by 2016. In the meantime, the Minister of State should be discussing this issue with GPs and putting in place the necessary supports to allow them to deliver on whatever decision is made.

Alex White (Dublin South, Labour)
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When decisions were made a decade ago in respect of the over 70s, I do not believe the Government of the day consulted GPs as to whether it should make the relevant policy choice.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am referring to the implementation of the policy.

Alex White (Dublin South, Labour)
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No Government would consult on such a policy choice. GPs and all other relevant practitioners are entitled to be involved in the discussions and, where appropriate, negotiations relating to the roll-out of any policy decision which affects them. However, policy decisions are a matter for Government and the Deputy can expect the relevant decisions to be brought forward in early course. I look forward to the support of Fianna Fáil in respect of universal access to GP care, particularly as I have never previously heard of that party advocating such care.