James Reilly (Dublin North, Fine Gael)

I am pleased to have the opportunity to address the Seanad on Second Stage of the Health (Provision of General Practitioner Services) Bill 2011. It is a very important Bill, not purely because it is a matter for the troika and one of the things it was concerned about. It is an issue for me as Minister for Health to ensure that, at a time when we have a manpower crisis in general practice, we do not have any impediment to young general practitioners who are suitably qualified or those who might wish to return from abroad achieving their goal of delivering care to patients in this country. If one is prohibited from treating 40% of the population or more in a given area it is a real problem and a disincentive.

The Bill provides for the elimination of restrictions on GPs wishing to obtain contracts to treat public patients under the general medical services scheme by opening up access to GMS contracts to all fully qualified and vocationally trained GPs. There will be no limits on the number of contractors, which is important. The new changes are being introduced on foot of the commitment to the EU-IMF programme which requires the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors, including eliminating restrictions on GPs wishing to treat public patients. As I have already pointed out, whether that requirement was there this Bill would have come to pass.

GPs can now only obtain GMS contracts in restricted circumstances as follows: where a vacancy arises due to the retirement, resignation or death of an existing GMS doctor; a new GMS panel is created in response to an identified need for an additional doctor in an area; or where a GMS doctor obtains approval from HSE for the creation of an assistant with a view to partnership within his or her practice. The HSE is currently required before filling a vacant GMS panel or creating a new panel to take account of the potential viability of the panel being established and the viability of existing GP practices in the area. When we are trying to create open competition, that is contrary to that principle.

These arrangements have prevented many young highly qualified and trained GPs from obtaining a GMS contract early in their careers. The current system allows them to treat private patients but they are not able to treat medical card or GP visit card patients until such time as they obtain a contract from HSE. They may have to wait several years for such an opportunity to present itself. This creates an additional difficulty in that somebody who has been in private practice for a number of years - a situation which is prevalent due to the current economic downturn - have had patients who have been with him or her for a considerable length of time and have developed good relationships with them. Some patients may find they no longer have a job and have to seek medical cards which results in having to change doctors. It is bad enough that people have suffered from losing their jobs, with all that means, but they also have to change from a doctor with which they have a trusting relationship.

In addition to the above, two other categories of GPs have certain restrictions placed on their rights to take on and-or retain GMS patients under the current arrangements. These are GPs who hold GMS contracts on foot of interim entry provisions put in place in 2009 where they would have to wait until 2013 before treating any medical card or GP visit card patient, and certain GPs involved in partnerships which have been dissolved or terminated before a specified period would not be allowed to retain patients under their GMS list at the time of the dissolution of a partnership. The Bill will remove these restrictions, which is only proper, right and fair.

When this Bill is enacted, new GMS contract holders will be free to establish a practice in the location of their choice. However, a contract holder approved by the HSE in an area and who wishes to move location may only do so with the prior approval of the HSE. This is designed to ensure continuity of care for patients. Nothing in the Bill prevents the Department pursuing its policy of ensuring proper provision in areas that may otherwise be unattractive.

We are aware that there is no general practitioner available in certain parts of Dublin, areas where there is very reduced availability and some rural areas with availability problems. It is these areas that we seek to support though various grants and aids. We do not want circumstances in which five new practices spring up on Grafton Street, each supported by public money. We are allowing and encouraging open competition and if people want this, it is fine, but we have a duty of care to people who find it difficult to access general practitioners because their areas are unattractive for various reasons. We need to put in place incentives to address that.

Section 1 provides for the definition of certain terms used in the Bill. Section 2 provides that the HSE will be entitled to enter into a GMS contract with any suitably qualified and vocationally trained GP and it will not be limited to granting contracts where a GMS contract holder dies, retires or resigns from the GMS.

Section 3 provides that a GP holding a GMS contract will be entitled to accept onto his list any patient nominating him as his doctor of choice, subject to existing rules relating to panel size. This reflects the original intention of the scheme; it was a choice-of-doctor scheme. If, because of the current restrictions, choice is not available to people - they may have been with a GP and now find they must get a medical card - it is clearly not for the good. This Bill will address that.

These rules stipulate that the total number of GMS patients who may be placed on a GP's list shall not exceed 2,000 save where the HSE or such organisation as follows it, in exceptional circumstances, decides to apply a higher limit. This will ensure that GPs who hold a GMS contract on foot of interim entry provisions put in place in 2009 will, from the date this legislation is commenced, be able to take any medical card or GP visit card patient onto their list and they will not have to wait for two more years before doing so.

Section 4 provides that when a partnership dissolves, a GP who wishes to continue participating in the GMS scheme may retain the patients on his or her GMS list on the date the partnership dissolves or terminates, unless the HSE is advised that any such patient does not want to remain on that list. Section 5 provides that the HSE, when filling or creating a GP position, will not take account of the short-term or long-term economic viability of that or other GP practices. This is important because it is not for us to determine the market. The provision will address a recommendation in the Competition Authority's report of July 2010 on general medical practitioners, which was aimed at increasing competition within the GMS scheme.

Section 6 provides that where a GP has been approved by the HSE to provide GMS services at a particular premises, he or she cannot provide such services at another premises unless he or she has submitted a request to the HSE and the HSE has given its consent. Therefore, a contract holder who wants to change his or her centre of practice can only do so with the prior approval of the HSE.

Section 7 provides that when this Bill is enacted, nothing in the Act will affect the operation of the GMS scheme other than the provisions set out in sections 2 to 6 of the Act. Section 8 provides for the Short Title and commencement of the Act.

A key commitment of the programme for Government and a fundamental element of the health reform process involves significant strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. This commitment will be achieved on a phased basis to allow for the recruitment of additional doctors, nurses and other primary care professionals. Access to primary care without fees will be extended on a phased basis over the life of the Government. Initially, free GP cover will be extended to persons in receipt of drugs and medicines under the long-term illness scheme. Primary legislation is required to give effect to this commitment. It is expected that the new arrangements will be in place by this summer. There will be announcement in due course on the commencement date for this arrangement.

The introduction of universal primary care will allow us to move away from the old hospital-centred model, in respect of which health care was episodic, reactive and fragmented, and to deliver a more proactive, joined-up approach to the management of our nation's health. By that, I mean it will become the focus of the primary care position to keep people well and engage in prevention and the monitoring of chronic illness so people will avoid complications and not end up in hospital, have a better quality of life and save the taxpayer considerable sums. It is a win-win situation for everybody.

I am confident that the Health (Provision of General Practitioner Services) Bill 2011 will contribute to this commitment as it will encourage more young GPs to remain and establish their practices in Ireland. It will make it more attractive for GPs to move here from overseas. There are many Irish graduates abroad who would like to come home but who have found it difficult to do so. The legislation will encourage competition among GPs at a time when many fee-paying patients have less money at their disposal.

This Bill will result in medical card and GP visit card patients having a greater choice under the GMS scheme. It will also help to ensure that private patients of new GP contract holders who qualify for a medical card or GP visit card will not have to change their GP. I commend it to the House and I look forward to hearing the views of members.