Michael Harty (Clare, Independent)
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4. To ask the Minister for Health the provisions he is making to unwind the provisions of the financial emergency measures in the public interest, FEMPI, legislation for contract holders, including general practitioners, GPs; and if he will make a statement on the matter. [28530/18]

Michael Harty (Clare, Independent)
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The FEMPI Act, as it applies to contract holders, including GPs, remains one of the most destructive legislative measures introduced in the history of this State. The disproportionality of its application to GP resources has undermined the financial viability and sustainability of general practice into the future. When will the Minister make provisions to unwind FEMPI as it applies to contract holders, particularly GPs?

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Harty for his question. I acknowledge the contribution made by health contractors through reductions in their fees to addressing the unprecedented economic crisis faced by the State when successive Governments, prior to and after 2011, found it necessary, in the interests of the financial crisis facing the State, to make reductions to public sector pay and to fees. I want to acknowledge that those reductions have been painful and extremely difficult. I have talked to many GPs who have articulated, just as Deputy Harty has done, the huge difficulty that has posed in terms of the viability of their practices. I acknowledge that it is a challenge through which we need to work our way.

The Public Service Pay and Pensions Act 2017, which was passed by this House at the end of last year, now allows the setting and varying of contractor payments on a non-emergency statutory basis. There is a new power now available to Government in respect of this, as passed by the Oireachtas.

It is my intention to put in place a new multi-annual approach to fees as part of the contract discussions currently under way in the first instance with the Irish Medical Organisation based upon health policy considerations and engagement with representative bodies.

As I said earlier, my Department and the HSE met the Irish Medical Organisation at the beginning of last month to set out the State's position on the general medical services, GMS, contract and on the issue of FEMPI.  The Department subsequently wrote to the Irish Medical Organisation to formally set out the proposals made at that meeting. This is a real opportunity for general practice to secure significant additional funding and to move to that post-FEMPI era if agreement can be reached.

In line with the long established approach to such processes, and by agreement of all the parties, including the GP organisation, I am not in a position to give further details while the discussions are under way but subject to the conclusion of arrangements in respect of GPs, my officials will examine the setting of fees for other contracted health professionals with any revision of fees also linked to contract discussions. We have started with general practice, after which we will examine the position regarding other contracted health professionals.

Michael Harty (Clare, Independent)
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I thank the Minister. I do not believe he appreciates the destruction the application of FEMPI is causing to general practice. It started in rural areas but now it is creeping into urban areas where it is impossible to attract GPs into the service. One of the principal reasons for that is the application of FEMPI. There has been a 38% reduction in the gross income of practices as a result of FEMPI. That is because the latter was applied to gross fees, not to the incomes of GPs. It is the gross fee which goes to support the structure of a general practice and not just the income of the GP. It has eroded the business model that has been sustained since the previous contract was agreed in 1972, some 46 years ago.

FEMPI has been unwound for all other public servants. There will be two pay increases this year and two next year but the Government has decided it will not unwind FEMPI for contract holders unless extra services are provided. It is tying that into the negotiations relating to the new contract. FEMPI was applied without negotiation but the Minister is using it as a stick with which to beat general practice in order to get the maximum out of the new contract. That is unprofessional.

The Minister must recognise the destruction FEMPI is causing to general practice. If he proposes to reform our health service, how can he expect it to be delivered if he does not have the GPs on which to build the foundation of a reorientation of health services from the hospital-centric scenario to a primary care model? The Minister must recognise - I do not believe he does - the destruction FEMPI is causing to general practice. He indicated that he has been speaking to GPs. He needs to engage with them. He needs to take charge of the negotiations because, in reality-----

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy will have another opportunity.

Michael Harty (Clare, Independent)
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-----there are no negotiations taking place at present. It is an exchange of letters. People are not sitting down and speaking to each other.

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy. I recognise the challenges and, more importantly, so does the Government. That is why we have taken a number of steps to try to address the issue of manpower and woman-power in terms of the number of general practitioners in the country. That is why we have significantly increased the number of training places. In 2009, there were 120 GP training places available. This year, it is expected that 194 training places will be filled. That is an increase of approximately 60% over a nine-year period. There were over 400 applications for the 2018 training programme, which is a significant increase of approximately 50% on the number applying to be GPs last year. That is an encouraging sign that more people wish to become GPs. More people are applying for the places and we are responding in kind by increasing the number available.

Keeping those GPs in this country is the challenge. That is why we need a new contract. I know from our exchanges publicly and our conversations also that the Deputy believes, as I do, that a new way of working as a GP, providing more supports and flexible working options is crucial in terms of a new generation of GPs. That is part of what we want to discuss as part of the contracts. We have already increased the rural support allowance from €16,216 to €20,000 per annum but we must remember that these are self-employed contractors. I have to look at it from the perspective of the GP. I have to look at it also from the perspective of the patient and the taxpayer.

Pat Gallagher (Donegal, Fianna Fail)
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The clock, please. We will have one more supplementary question.

Simon Harris (Wicklow, Fine Gael)
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I have to wear all three hats in that regard. We have to pay a fair fee for a fair service. We need to negotiate the fee and the service-----

Pat Gallagher (Donegal, Fianna Fail)
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This is getting out of hand.

Simon Harris (Wicklow, Fine Gael)
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-----and that engagement is getting under way.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy has one minute to respond. I ask him to confine himself to that.

Michael Harty (Clare, Independent)
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The Minister has referred to training places again. If he is going to use training places as a means of sorting out this problem, he is way behind the eight ball because of every 100 GPs trained, 50% will not be working in general practice in five years. They will have left the service to work in other parts of the health service. They will have emigrated or they will be working on a part-time basis.

In his initial reply, the Minister seemed to indicate that there is not a problem with the recruitment of GPs. He has figures which state that there are more GPs holding contracts now than was the case at any other time. Many of those GPs are not working full-time in general practice. Many of them do not have patients on their list. They have taken out GP contracts but they are not actually working full-time. If the Minister believes there is not a manpower crisis in general practice, he is deluded. There is a huge manpower crisis in general practice. If he proposes to develop a Sláintecare response and a reorientation of our health service from a hospital centric model to a primary care centric model and he does not have the GPs but continues to say we have many GPs and that we do not have a problem, he is out of touch. He is not talking to the right people. He has to take charge of the negotiations of a new GP contract because if he is leaving it to the current negotiators, there is nothing happening. The Minister has been in office for 800 days. Sláintecare was published 390 days ago.

The Minister has done nothing to reform the health service and it is frustrating to have him say there is not a problem. There is a huge problem and the Minister has to recognise it.

Simon Harris (Wicklow, Fine Gael)
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That might be a fine speech but it does not tally with the reality. The Government and I have taken a number of actions to reform the health service, and to try to turn around what is a major tanker and get it to a place where we can reform it. We supported the establishment of an all-party committee and people on the Government benches worked extremely hard to come up with a cross-party plan as well. That plan is not just owned by Deputies on the other side of the House. We are determined to deliver it. I will bring a Sláintecare implementation plan to Government before the summer recess, but I will bring one can be implemented and that addresses the challenges and does not duck the hard questions about how we fund these measures and how we make sure we get the sequencing correct. If we implemented Sláintecare in the order it is in today, I guarantee the Deputy's GP colleagues would not be happy about the immediate rush to universal free-for-all without addressing the capacity issues. I have had to work hard to put a structure and a sequence on the Sláintecare report in order that that it can be implemented, which is recognised by the Deputy's colleagues in the NAGP and the IMO.

I have a direct responsibility to make sure we train enough healthcare professionals. We are training more nurses than ever before and we are dramatically increasing the number of training places. However, I take the point. The Deputy must not misrepresent me, accidentally or otherwise. I accept there is a challenge in respect of general practice. We will resolve it in a negotiation in which both sides have ask. That is under way.

Pat Gallagher (Donegal, Fianna Fail)
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We are losing a lot of time. I ask Members to respect the clock.