Bríd Smith (Dublin South Central, People Before Profit Alliance)
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71. To ask the Minister for Health his plans to improve general practitioner coverage nationally in view of the strain that the proposed legislation on abortion rights will put on general practitioners and access for women nationally. [43626/18]

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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On this historic day, most Deputies are very happy that the House voted by a margin of 10:1 to progress the Health (Regulation of Termination of Pregnancy) Bill. My question concerns the level of general practitioner, GP, care available. There is a crisis in GP care. How will it be affected when women want to access termination services in January? What plans does the Minister have to improve the level of GP care?

Simon Harris (Wicklow, Fine Gael)
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I thank the Deputy for her question. As she is aware, preparations for the implementation of the termination of pregnancy services are at an advanced stage. I welcome that the House passed the Bill through Second Stage, which is crucial, as is ensuring that the services will be ready to be put into operation. As the Deputy is aware, it is envisaged that most terminations up to nine weeks of pregnancy will take place in the community setting. Several medical practitioners have expressed an interest in providing termination of pregnancy services. The Deputy heard the evidence of representatives of the Irish College of General Practitioners in that regard to the Joint Committee on the Eighth Amendment of the Constitution. Officials in my Department and the HSE are drafting contractual proposals for the provision of these services. It is intended that the contract will be available to qualified medical practitioners who wish to provide the services as well as organisations that provide women’s health services. It is vital that we have safe, accessible, woman-centred termination of pregnancy services in place by January 2019 and the Government has provided additional resources in the recent budget to ensure that will be done.

More generally, engagement is due to recommence tomorrow with GP representatives on a package of measures including service improvements and reform to the general medical services, GMS, contract. I recognise that GPs, like very many people, suffered additional burdens and costs during the financial recession. I wish to move to a situation where their careers and operation in the community are far more sustainable. I have reached agreement with the Minister for Public Expenditure and Reform, Deputy Donohoe, on a multi-annual investment programme in general practice and I am delighted that representatives of the IMO will meet officials of my Department to try to make progress on this. We have set a deadline of the end of the year for progress. That relates to the Deputy's broader point on the sustainability of general practice as we ask GPs to take on new services.

Specifically on the provision of termination services, my Department and the HSE are drafting contractual proposals in that regard. We will resource general practice to provide the services. As I consistently stated during the referendum campaign, it is important to note that this will not in any way overwhelm the Irish health service. That possibility is not often raised in the context of other conditions or GP attendances.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I am sure the Minister has a better handle on the numbers etc. than do I, but they are quite alarming. The average number of doctors per 1,000 patients is 3.3 in the OECD but in Ireland it is 2.7. Unless those figures rapidly change, that will require action, particularly in areas where GPs see more patients than is the case in other areas. North inner city Dublin has the highest level of patients to doctors in the country at 1,218 patients per GP, while next in line is a rural area, Laois-Offaly, where there are 1,176 patients per GP. Combined with the imposition of a three-day waiting period and the possibility of doctors opting out of or conscientiously objecting to the provision of these services, there could be flashpoints in which there will be real problems accessing services to terminate pregnancies.

We must also very seriously consider the level of general GP care across the country. That needs to be addressed. An alarming 31% of current GPs are due to retire from the profession in the next five years. How will we replace that level of care in a timely fashion?

Simon Harris (Wicklow, Fine Gael)
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We are providing for extra GP training places. It is not good enough just to train more GPs; we must work to ensure that general practice is and will be a sustainable career for those studying to become a GP. That is why we are providing a programme of investment as well as extra training places. Talks on that general programme of investment are to take place tomorrow with the IMO, which has asked for the matter to be resolved before the end of the year and that a multi-annual programme of investment for general practice be implemented. I accept that general practice took a hit in that during the economic recession under successive Governments.

Beyond that, in the budget we provided specific resources relating to the termination of pregnancy, as the Deputy is aware. As she is also aware, I have appointed Dr. Peter Boylan to work with the HSE to ensure these services are ready. An issue raised with me by GPs and the medical colleges is the provision of a medically operated out-of-hours telephone service as an extra support for women and doctors and I have directed the HSE to have that service in place by January.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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Members will have the chance to table amendments to the legislation. The three-day waiting period and two doctor visits into which women will be forced will cause genuine problems, particularly in flashpoint areas such as parts of rural Ireland and poorer areas of inner city Dublin with a far higher ratio of patients to GPs than the rest of the country.

An interesting article in The Irish Timestoday addressed the question of conscientious objection. The writer pointed out that doctors may object to providing the services not because they have a problem with dealing with terminations but because they have a problem with a work payment situation. Under FEMPI, doctors' income was cut by 25% and that has not been reversed. Numerous problems must be dealt with but my fear is that having repealed the eighth and gained access to termination the women of this country will encounter real problems accessing GPs to deliver that service, particularly in more vulnerable areas such as isolated parts of rural Ireland or poorer parts of inner city Dublin.

Simon Harris (Wicklow, Fine Gael)
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I have addressed the issues of FEMPI cuts and investment in general practice by outlining the process we intend to undertake and on which there will be further engagement with the IMO tomorrow.

I will save my comments on how the service will operate in terms of the three-day period for Committee Stage of the Bill, when there will be an opportunity to engage on such issues. My basic premise is to do what I stated I would do during the referendum. We asked the Irish to vote "Yes" and we published a draft general scheme which was debated the length and breadth of the country. Regardless of my personal views, I have a responsibility and a duty to move ahead with legislation that is very closely aligned from a policy perspective to what we stated during the referendum campaign we would do.

On GP numbers, the Deputy and I are largely on the same page on the issue of termination. Those on the other side of the debate often raise concerns that not enough GPs will be willing to provide this service or they will be overwhelmed by the number of women seeking to avail of terminations or awful phrases such as that. The evidence does not supports such views. Many doctors put their names forward during the referendum campaign as being willing to provide such services. The Irish College of General Practitioners indicated its views in that regard to the joint committee and I am confident that we can make progress on the matter.