Marc MacSharry (Fianna Fail)

As always, I welcome the Minister to the House. He has a very difficult job. He is very busy and we are glad to see him here in person. That is not to say his Ministers of State are not very welcome here.

Fianna Fáil, as the Minister will have heard from Deputy Kelleher in the Dáil, welcomes this Bill in principle and would like to assist in improving it on Committee Stage, if possible. While none of us welcomes our having to deal with the troika and IMF, in a strange way this Bill represents a positive consequence of their involvement. It represents a deregulatory task that should have been done quite some time ago. Everybody qualified as a GP should be allowed to make himself available for practice, particularly at a time when there are shortages in parts of the country, as the Minister rightly stated, in regard to the provision of care.

I wish to make a point on the availability of GPs that is not related to this Bill. It concerns the points required to enter medicine courses. In another debate, during which the Minister may have been present, I said that while I had no doubt the he received top marks in all his subjects, many of his colleagues, who are very fine GPs and medical practitioners, were not required to get straight A's in all the various subjects required to enter the Royal College of Surgeons or other medical colleges. Let me outline the case of a particular GP, on whom I will not give too much information for fear Members may know who I am speaking about. In the 1960s, when replying to a newspaper advertisement seeking students for the Royal College of Surgeons, whose entry criteria required one to have passed one's leaving certificate and to have two languages, he put down Irish as the native language and English as the foreign language. The individual in question is happily practising as an excellent GP to this day.

I am not saying we should be flippant about the level of attainment required to enter medical school but that we should be non-elitist - more so than in recent decades - in encouraging people. People who are probably more suited to being librarians are encouraged, through peer pressure, to study medicine if they happen to earn the requisite number of points. We need to focus more on who we encourage to enter the profession and be less rigid in requiring straight A's. I would like the Minister to reflect on this in his ongoing work.

While there is no doubt that the Bill will have positive implications owing to deregulation, it poses questions. I do not see any provision that will ensure GPs will want to go to non-affluent areas, nor do I see a provision to discourage those currently in non-affluent areas from transferring, albeit with HSE permission, to an area that they want to be in and which may be a little better. There is no provision to ensure out-of-hours cover to the extent required nationally. I fully agree with the Minister that we ought to move away from resorting to the hospital or intensive care when there is a basic concern and that the system should be much more GP focused.

We want to move away from a position where people automatically think of hospital or intensive care when there is a basic concern. The system should be much more GP-focused. However, very often GPs have not made themselves available for this. Most of the general practitioners I know start at 10 a.m. on a Monday, stop for lunch for a couple of hours, finish at 5 p.m. and have their on-call periods. Almost all of them golf either on Wednesday afternoons or another afternoon during the week. That is the case. The Minister is shaking his head. I would love to do an analysis of the golf courses of Ireland in about 90 minutes' time and count how many GPs are out playing on Wednesdays. I can assure the Minister there are quite a few. There are very few professions that provide for that but I am afraid this one does. That is something we must deal with. One could follow it with the number of hours during which certain consultants make themselves available. That is a challenge for us to change.

In any case, I do not see how this legislation will help with pricing. General practitioners charge what they charge throughout the country and we do not have price caps unless the Minister were so to direct. Obviously, there has been a 15% reduction in terms of GMS payments to doctors. Who negotiates for doctors now? Under competition law the IMO does not. Rephrasing what the Americans said famously about Europe, when one wants to speak to GPs who does one speak to, if not the IMO? According to the competition authorities it is not to the union, so where is the line of communication? How can we get across to doctors they need to start taking on board some of the points we mentioned, from pricing, to availability, to out-of-hours access, and the non-gin and tonic belt locations which some doctors may not care to cover but which need to be covered?

There are positives here but many questions have been raised as well and we will try to assist with that on Committee Stage.

In the context of services throughout the country the equality of access issue is one that is very close to my heart, as the Minister knows. I would not be true to myself if I did not use this opportunity to ask about this, in the context of the HSE and the very admirable policy of trying to match up with international best practice across the various disciplines. We have had the national cancer control programme, which many people are very happy with, in spite of everything. Professor Kieran Daly is implementing reforms in the area of stenting. The Minister and I have corresponded about the recommendations implemented by Professor Daly that are associated with improving cardiology. My concern is that, statistically, 80% of the people of the country have this care, within whatever the reach may be. However, as the Minister knows well, in the north west of the country the national cancer control programme does not cater for equality of access. In spite of the Minister's announcements in the House regarding follow-up mammography at Sligo General Hospital this still has not happened.

There is also another scenario. International best practice claims that if one has a heart attack it is necessary to insert a stent within 90 minutes. We are implementing a programme of reforms to match up to that standard yet, by the admission of both the Minister and the HSE, this does not take account of the north west of the country on the basis that only 20% of the country's population is involved. The people in that region can be treated as for thrombosis because that is the best we can do. In essence, what is meant is that the people of the north west can either move closer or they can die. They will have less likelihood of survival than the rest of the country which has proximity, in cancer to the national cancer control programme with its eight centres, in radiotherapy and in other treatments that are available. In terms of cardiology and stenting the people of the north west must survive on thrombosis treatment.

I welcome the Bill but while we are all striving to make greater equality of access and cheaper treatment for all the people of the country in terms of GP care - never mind who is in government - is there a HSE policy to match international best practice across disciplines? It still uses the excuse that 80% of the people are covered so the people of the north west, who have very particular geographical and proximity concerns, can sing for it. If we hide under the cloak of lack of resources and everything else, we will not do it. I would like to hear the Minister's views on this issue.