Seán Crowe (Dublin South West, Sinn Fein)
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33. To ask the Minister for Health the total subventions paid from the public HSE budget to general practitioners by supplement for employment of staff; and if he will make a statement on the matter. [4570/17]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The question is very simple. I ask the total subvention paid from the public purse to GPs on an itemised basis if possible. I do not expect the Minister to read out all the figures but to give us a flavour of them, if he would be so good.

Simon Harris (Wicklow, Fine Gael)
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If I do not have adequate information here for the Deputy, I will revert to Deputies O'Reilly and Crowe.

The development of primary care is central to the Government's objective to deliver a high-quality, integrated and cost-effective health service. The programme for Government, as Deputy O'Reilly knows, commits to this decisive shift within the health service towards primary care in order to deliver better care closer to home in communities across the country, and I recognise that general practice has a key role to play in this context.

GPs contracted under the general medical services, GMS, scheme provide services to people who hold a medical card or a GP visit card and are remunerated for these services primarily on a capitation basis, with a range of additional support payments and fees for specific items of service. In 2015, the HSE made payments of approximately €464 million to GPs for the provision of general medical services for about 2.17 million eligible people, of which €81.6 million represented contributions towards the employment of support staff. Last year, total payments to GPs under the GMS scheme were in the region of €500 million, of which €85.3 million represented contributions towards the employment of support staff.

The Government is committed to ensuring that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas into the future. I want to ensure that existing GP services are retained and that general practice remains an attractive career option for newly qualified GPs.

I am cognisant, as the Deputy and everyone else will know by this stage, of the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector. Health service management has already progressed a number of significant measures through engagement with GP representatives. The GP contracts review process, which has recently recommenced, will seek to arrive at further measures aimed at making general practice an attractive, fulfilling and rewarding career option into the future.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The Minister talks about wanting to make general practice an attractive option for GPs. It would be marvellous if it were an attractive option for practice nurses as well. A total of €81.6 million is spent on staffing, and a further several million - more than €21.5 million, I think - is spent on fee per procedure or fee per item. Does the Minister not think it would make more sense if the HSE directly employed those practice nurses and, to the extent possible, did away with the fee per item? I recall when other health professionals were being paid on a fee-per-item basis that there was much handwringing from Fianna Fáil, which I believe was in Government at the time, because the fee per item was not deemed to be good value for the public purse. This is an area where fee per item is rampant. Will the Minister give some consideration to the direct employment of these practice nurses?

Simon Harris (Wicklow, Fine Gael)
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The short answer is "I will". I know the Deputy's views on this, and we have had an opportunity to discuss them a little before. I refer to the question as to who employs the staff within primary care as it is developed. I will be influenced by the views of the cross-party group in this regard and the report of that group. The Deputy obviously recognises, as must I, that we currently operate under a GP contract. Schedule 8 of Statutory Instrument No. 233 of 2016 makes provision for the payment of subsidies to GMS contract holders towards the cost of employing support staff, namely, practice nurses, secretaries and practice managers. The rates of these payments are calculated according to a pro rataformula, whereby there is a sliding scale based on a patient panel size of 100 to 1,200 patients. The maximum payment rates apply where a GP has a panel size of 1,200 patients or more. As I said, this is set out in Schedule 8, which I will send to the Deputy. Each patient aged 70 years or over counts as two patients when calculating a GP's panel size for the purposes of these allowance. Finally, where a GP qualifies for supports under the rural practice support framework, he or she is entitled to practice support subsidies towards the employment of a practice nurse, secretary and-or manager at the maximum applicable rate regardless of the size of the patient panel. I will reflect on the Deputy's comments.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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For example, the Primary Care Reimbursement Service, PCRS, data for 2015 indicates excisions, cryotherapy and diathermy - basically, the removal of skin lesions - amounted to 156,996 procedures at a cost of nearly €4 million. Given that there will be a renegotiation of the general practitioner contract, there is substantial scope to give direct employment to practice nurses and reform the way the process is paid for. I did not agree at the time when there was hand-wringing about the fee per item but I would be inclined to agree in this case that perhaps the fee per item is not getting the best value for money. The renegotiation of the GP contract gives the Minister and his team the opportunity to examine this.

Simon Harris (Wicklow, Fine Gael)
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As I stated, I will reflect on the Deputy's comments and the views of the Oireachtas Committee on the Future of Health Care because getting this right is very important in terms of the development of primary care. I had the opportunity to address the annual conference of practice nurses recently and I heard from them some concerns about anomalies. They felt colleagues in most other settings across the health service have the possibility of engaging in educational opportunities, which they do not, and I have committed to engaging with practice nurses further on that. It is an important issue. My Department will also publish shortly policy proposals on the further development of the role of the public health nurse and engage with stakeholders and consulting in regard to that as well. Getting primary care right is absolutely about a new GP contract but it also involves a range of other health care professionals. We are at an early stage of the contract renegotiation and the Health Service Executive and the Department of Health have had initial engagement on the broad range of issues with two representative bodies of GPs. It is a very substantive body of work and I expect the negotiations to take the bulk of 2017.