Billy Kelleher (Cork North Central, Fianna Fail)
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42. To ask the Minister for Health the position regarding the provision of a new general practitioner services contract; and if he will make a statement on the matter. [29222/17]

Billy Kelleher (Cork North Central, Fianna Fail)
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My question is to ask the Minister for an update on the position regarding the provision of a new general practitioner, GP, services contract and if he will make a statement on the issue that I have raised. As we are well aware, there has been strong emphasis over many years on the provision of primary care, the enhancement of services in the primary care and community care setting, and the issue of a new general practitioner services contract is central to that evolution in health provision in primary and community care.

Simon Harris (Wicklow, Fine Gael)
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A core tenet of Government policy is the development of primary care, which is central to the Government's objective of delivering a high-quality, integrated and cost effective health service. The aim is to develop a new modernised GP contract which will facilitate the shift within the health service away from hospital services towards an integrated primary care service in order to deliver better care close to home in communities across the country.

I want to see a new contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. It should be flexible and be able to respond to the changing nature of the GP workforce. It should also include provisions for service quality and standards, performance, accountability and transparency. These are realities in today’s world which must be accommodated. I think this will be key in making general practice a more attractive career.

Since 2015, negotiations have resulted in a number of service developments, including the provision of free GP care to under sixes, over 70s, the introduction of a diabetes cycle of care for adult general medical services patients with type 2 diabetes, and enhanced supports for rural GPs. The next phase of engagement with GP representatives is under way. The discussions taking place are wide-ranging and ambitious in their scope. While there will be challenges for all parties involved, I am hopeful that with the goodwill and co-operation of all parties, significant progress can be made in these discussions in the months ahead. I made it clear around budget time, as did the GP organisations, that this body of work was always going to take the overwhelming bulk of 2017. It is a very substantive body of work. I hope that everyone will remain focused on our common goal of putting suitable new arrangements in place that will work for patients, for GPs and for other health care providers in primary care.

Billy Kelleher (Cork North Central, Fianna Fail)
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The problem with the Minister's answer is that we have been waiting for a long time for discussions to commence. That was a commitment made by the previous Government. We are now in a situation where we have the Sláinte report. It has identified key recommendations in the area of provision of primary community care, enhancing the services in disease prevention, chronic disease management, moving from a hospital-centric health service to a primary and community care setting and, of course, the key issue in all that is the issue of capacity within the primary care setting. That is fundamental to the delivery of the recommendations in that report, which are also in line and in tandem with Government policy about expanding the primary care setting. The Minister talks about under sixes and over 70s, but the harsh reality is that until the Minister expands and enhances the capacity of GP services in the community, we will not be able to provide what has been identified both in Government policy and in the Sláinte report from the committee chaired by Deputy Shortall. I ask the Minister to give an outline as to whether or not the challenges are because of lack of resources, funding, lack of personnel to roll out the proposals or because there is prevarication, either by the representative bodies or by the Department of Health and the Government.

Simon Harris (Wicklow, Fine Gael)
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I welcome my new colleague in the Department of Health, the Minister of State, Deputy Jim Daly, who I know will bring vigour and energy to his areas of responsibility.

I do not think there is anything wrong with my answer, because GPs and patients have been waiting for at least three decades for a new GP contract. Within weeks of coming into office, I began the process of engagement to put one in place. We have a situation whereby those negotiations are already under way. A process has been put in place for further engagement with GP representatives. Meetings with the Irish Medical Organisation, IMO, are held on a fortnightly basis, with some further meetings at an official level to discuss technical issues or, indeed, at a clinical level. There have also been consultative meetings with the National Association of General Practitioners, NAGP, and, as I have said, I expect a situation where we will see substantive progress made by the end of the year with regard to delivering a new, modern, fit for purpose GP contract. I am strongly of the view, as I think are GPs, that this should not be a static document. We should not do what all of us have done in the past, putting one static contract in place.

We should modernise the contract and then keep the engagement ongoing.

In relation to Sláintecare, a substantial body of work on which I am looking forward to having a debate in the House tomorrow, it is likely that legislatively changes will be necessary for any substantial extension of GP care without fees to further cohorts of the population. It is clear that GP capacity must be addressed as well. I look forward to expanding further on those matters in the conversations tomorrow and in the contractual negotiations.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister's predecessor, now the Taoiseach, stated when he was Minister for Health that he hoped the negotiations would be concluded by April 2016. It is now June 2017. There has been a substantial amount of drift in terms of the negotiations. When does the Minister envisage these negotiations concluding? If we are to convince the public that the Sláintecare report, which is in line with broad Government policy in terms of the provision of primary care, expanding and enhancing those services, increasing capacity and trying to bring about universal access in primary and community care, these issues are critically important. They will require legislative changes. However, we need to see an end date in place. Could the Minister give us a rough estimate, at least more accurate than his predecessor's, of when those negotiations will conclude?

Simon Harris (Wicklow, Fine Gael)
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My predecessor, now the Taoiseach, is committed to cracking the challenges once and for all as a country that face the health service and he made that clear in one of his first speeches as Taoiseach in this House. I share that view and that commitment.

I expect to make substantial progress on a new GP contract this year, but I am also saying that should not be the end of the matter. This will be a multi-annual process. Let us try and have a number of wins for patients and indeed wins for GPs who we need to be able to have a viable career pathway so we can have GPs in every community this year.

As well as expanding free GP care - in fairness the programme for Government commits to expanding free GP care to all children under the age of 18 subject to negotiations with GPs in the lifetime of a five-year programme - a priority for my Department and for me is to look at chronic disease management. We need to look at things that could be done today in the community, and in other countries are done in the community, that are currently being done in the acute hospital setting. I expect to make substantial progress within this calendar year.