Michael Kitt (Fianna Fail)

I welcome the Minister of State to the House and I am pleased to have an opportunity to speak on the Fottrell report. I discussed undergraduate medical education with Professor Fottrell, who has produced an excellent report, many years ago when he was president of University College Galway. We are all aware of the difficulties arising from the high points required to gain entry to medicine and the large number of foreign students studying medicine here. I am also aware of the economic implications of the latter.

For some time, the Government and universities have examined alternative approaches to undergraduate medical training. For example, graduate entry, which has been available in veterinary medicine for some years, was recently introduced for medicine. This is a worthwhile approach in that it also includes an aptitude test and interview.

Senators raised the shortage of medical practitioners, an issue also highlighted by the Irish Medical Organisation. The problem is particularly acute in rural areas and is likely to worsen as more general practitioners retire. A GP who chooses to live in a rural community makes an advance commitment to the community and, as such, should be provided with assistance, including additional resources to develop a practice.

Since the introduction of out-of-hours GP services, it has become clear that some of the catchment areas are too large. The reasons for this are a shortage of GPs and a lack of resources. The Westdoc region, as it is known, has a good structure in place, with drivers in vans and jeeps available to drive general practitioners to patient visits. Sometimes, however, doctors are required to travel excessive distances. People living in Galway, for example, should not have to depend on a service operating out of counties Mayo or Roscommon or vice versa. Will the Department consider introducing new centres to reduce the distances between patients and doctors? The co-operative system works well but catchment areas are too large and doctors must travel too far. Ten years ago, doctors worked on rota every third or fourth weekend. This has changed and they are now driven to patients. In the western region one can at least notify the Health Service Executive of problems with the out-of-hours GP service, whereas the service is privatised in some areas, which is the wrong approach.

Hospital doctors work hard and would have a more structured life if they worked regular working hours. General practitioners who participate in the out-of-hours service must work long hours and be prepared to get out of bed in the middle of the night to care for patients.

We all agree that the points required to enter medical school are high but, as Senator Norris noted, the current system provides an objective assessment. It is possible other forms of assessment would be inferior. Nevertheless, the high number of points required demonstrates that the numbers of entrants to medicine and doctors in our hospitals are too low. I support the Fottrell report's recommendations in this regard.