Dáil debates

Thursday, 28 June 2018

Ceisteanna - Questions - Priority Questions

General Practitioner Contracts

10:30 am

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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1. To ask the Minister for Health the status of the negotiation of a new general practitioner contract, the engagement he has had with an organisation (details supplied) in the negotiations and if he will make a statement on the matter. [28600/18]

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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As the Minister for Health will be aware, the GP sector is in crisis. GPs have faced repeated cuts, there is an almost complete breakdown in relationships between GPs and the HSE and there are massive recruitment and retention problems. According to some estimates, seven out of ten GP surgeries are no longer taking in new patients.

One of the keys to rebuilding the sector is a new GP contract. Sadly, one of the organisations that is key to this, the National Association of General Practitioners, NAGP, which represents approximately 2,000 GPs around the country, has been left out in the cold. Despite repeated letters to the Minister, the Taoiseach and the assistant secretary in the Department of Health, the association has not been had any meaningful interaction and it has not been allowed to come to the table to join the negotiations the Irish Medical Organisation, IMO, is engaged in. Why has the NAGP been left out in the cold in these critical negotiations? What is the Government's plan to bring the association inside in order that it can be part of negotiating a GP contract fit for the future?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I thank the Deputy for his question. He is correct to highlight the fact that there are number of challenges facing general practice we need to work on, including the resourcing and, most importantly, ensuring it is well positioned to serve the community now and into the future in line with the Sláintecare report. It is important to acknowledge the factual situation. The number of GPs on the specialist register continues to increase. There were 2,270 GPs on the specialist register in 2010 compared with 3,668 GPs as of 18 May 2018. The number of GPs contracted by the HSE under the general medical services, GMS, scheme has increased from 2,098 in 2008 to 2,497 as of 1 June 2018. The number of GPs providing services under the GMS contract has increased, therefore, along with the number of GPs registered on the specialist register. There are challenges, as we have an ageing and growing population and more chronic diseases that need to be managed in our community. I do not dispute that in any manner.

General practice is one of the cornerstones of the health service. The Government is committed to engaging with the representatives of GPs on the development of a package of measures and reforms to modernise the 1989 GMS contract. Our goal is to develop a contractual framework that has a population health focus providing, in particular, for chronic disease, structured care for chronic disease in the community and up-to-date provisions on service quality and standards, performance and accountability. Officials from my Department and the HSE met the IMO at the beginning of May to set out the State's position. The Department subsequently wrote to the IMO setting out these proposals formally. In line with the long established industrial relations approach to such processes, and with the agreement of the parties concerned, I am not in a position to give further details while this engagement is under way. That is normal during negotiations.

I acknowledge that the NAGP is also anxious to be involved in discussions about reform of the GMS contract. I have indicated my willingness to consult the association formally on the many issues facing general practice and I anticipate that arrangements in this regard will be made in the coming weeks. My Department has written to the NAGP in this regard pointing out that we would commence discussions and negotiations with the IMO, which is a member of ICTU. That is how the State does its business on many contractual issues. However, the Department also stated that we would also provide the NAGP with an opportunity to contribute meaningfully to that. That will happen in the coming weeks and I have put that in writing to the NAGP. I look forward to positive and productive engagement with all parties concerned. The delivery of these new measures for general practice is a priority for Government.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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While I accept that the Minister is speaking in good faith, I have read all the correspondence from his Department to the NAGP and none of it gives any dates whatsoever. I will refer to the timeline. On 13 March 2018, the NAGP wrote to the Minister seeking a meeting on the referendum on the eighth amendment. It was concerned about talks about a GP-led service when GPs were not being consulted on that. There was no response from Government to that letter. On 23 April 2018, the association wrote to an assistant secretary in the Department seeking a meeting to discuss the various issues raised. There was no response from Government to that letter. On 21 May 2018, the association wrote again to the assistant secretary, copying the Taoiseach and the Minister. In the letter, the NAGP expressed disappointment at the lack of a response from Government to the issues raised. The association again requested a timeline for engagement on FEMPI and the new contract citing the fact that the IMO had started negotiations and quoting the Minister's own commitment. It received no response from Government. On 31 May 2018, the NAGP wrote again to the assistant secretary, included the previous letters and cited the lack of response. The association raised four issues: FEMPI, the new GP contract, CervicalCheck - it was concerned that it was not getting the information it needed - and the implementation of the referendum outcome. As of 24 June 2018, it received no response to that.

It has received one letter from the Government stating that at some point in the future, the Government will engage with the association. Does the Minister believe that is an adequate response from the Government to date given that the Minister has given a commitment to engage with the association, which represents over 2,000 GPs?

10:40 am

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I believe we are following the correct sequence to bring about a new GP contract. It is the position of the Deputy's party and of all parties in the House that the Irish Congress of Trade Unions, ICTU, has a crucial role in how we do our business in respect of industrial relations. The Irish Medical Organisation is a member of ICTU and it is the body with which successive Governments, including those led by the Deputy's party, have engaged on delivering issues for general practice and for the health service generally. The NAGP has a constructive role to play and it has some good ideas for how to reform and improve our health service. I want to engage with it in that regard. In doing so, I will be the first Minister for Health to engage with the association and bring it into a process. However, I must respect the structures in which we operate and the agreements we have for how these processes are carried out with the Irish Medical Organisation. As the financial emergency measures in the public interest, FEMPI, and these issues were negotiated when both the Deputy's party and my party were in government through the ICTU structures and engagement with ICTU, it is appropriate that I begin the conversation with the IMO. The NAGP will have a role to play.

With regard to the eighth amendment, I fundamentally disagree with the approach being adopted by members of the NAGP in this regard in terms of the sequence. We will agree the clinical guidelines first with the medical colleges, which includes the Irish College of General Practitioners, and then we will engage on how we will resource it. We will get the clinical guidelines right. I do not wish to see the issues around implementing the mandate of the Irish people in the referendum being conflated, and the Deputy is not doing this, with issues regarding FEMPI and the future of general practice.

I thank the NAGP for the constructive role it played with regard to CervicalCheck. Its president did an excellent job in putting forth important information about the screening programme. The association has a role to play and we will engage with it in the coming weeks.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Minister is right that the eighth amendment is a separate issue, but I was concerned that the NAGP was hearing Ministers talk about a GP-led service when it, as the representative of many of the GPs, has not been consulted. Similarly, the association wrote to the Minister about CervicalCheck pointing out that although the Minister was saying that GPs would play a big role in supporting the women concerned, the association could not get any information from him. When it cannot get responses from the Government to those letters, one must be worried.

However, this question is about the negotiation on the GP contract. In August 2016 the Minister said the following: "I think it is absolutely essential that we have the new contract negotiated and I want to see the NAGP as part of that ... what I am doing is saying very clearly that when we get down to negotiating the GP contact, which I expect to happen by the end of the year [which was by the end of 2016], that the NAGP need to be in the room". It is now two years later and the negotiations on the GP contract started months ago. The NAGP, on foot of this promise, has written to the Minister repeatedly but it cannot even get a letter in response to say when he expects its representatives to be in the room. Does the Minister think that is sufficient or have the Minister and the Department fallen short of the standards and level of engagement required in this case? Will he now give the NAGP a clear timeline for when it can negotiate as well?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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While it has taken longer to negotiate a new GP contract than I would have liked, I should point out that we are discussing a contract that has been in place since 1989 and we are going to deliver significant reforms to general practice. Deputy Harty has been a strong advocate for this for a number of years as well. I believe the sequence we are following is correct. If a different sequence were put in place it would be a significant cause of concern for organisations such as the Irish Medical Organisation and possibly, by extension, the broader industrial relations mechanism in this country. We negotiate with the Irish Medical Organisation but I did say, and I stand by what I said, that we must have an inclusive process that enables other organisations to put forward their ideas. Incidentally, the NAGP has some very good ideas. The NAGP will be formally consulted and it received correspondence to that effect. I had a number of conversations with leadership figures in the NAGP, as I do with all stakeholders across the health service. They will hear about their opportunity to contribute to the process in the coming weeks.

My priorities have been, first, deciding the State's position for the contract negotiations and, second, getting that position endorsed by the Government. There is no point in it just being the Minister for Health's position as it is necessary to have the buy-in of the Department of Public Expenditure and Reform, which I have now. Then there is an initial discussion in which we present the State's position to the IMO, which we have done, and then we provide an opportunity for other stakeholders, including the NAGP, to contribute.