Seanad debates

Wednesday, 8 February 2012

Health (Provision of General Practitioner Services) Bill 2011: Second Stage

 

12:00 pm

Photo of Colm BurkeColm Burke (Fine Gael)

I welcome the Minister to the House. I also welcome the students who have joined us in the Visitors' Gallery. I hope the debate relates to their careers and that in the not too distant future we will see some of them as part of the medical profession here, able to practise in this country.

This new Bill gives the right to practise to those who meet the required criteria. The restrictions that were there previously did not comply in real terms with EU regulations. I was surprised and mesmerised that nobody had ever challenged them because they were anti-competitive. I took out the 1996 circular issued in respect of this entire issue which set out how people were to be appointed. This was an amendment to earlier regulations and I am sure it, too, was amended since 1996. The criteria as set out allow for the provision of a proper level of access to general practitioner services for patients. They state patients should have a reasonable degree of choice in selecting a practitioner and that due regard is given to the question of viability of practice in the area in question. Viability of practice, therefore, was one of the criteria in deciding whether an appointment should be made.

It was interesting to look at the appendix 4 regulations on deciding whether a person should open a practice. These examined the number of GMS patients on the list, the age and gender profile of the patients, the geographic area in which the practice is situated, the number and age profile of GMS doctors in the area and their list sizes. Also included were the private practice profile of the area in question, including the ratio of private to public patients, the population size of the area and surrounding areas and the factors advanced by the applicant doctor in support of his or her application. Although many issues were taken on board there was not the freedom for a person to come in and open up a practice. Applicants could open up and be involved in private practice but they were not entitled to take on people with medical or GP cards. This new Bill allows the whole area to open up and I welcome it.

There is another issue which I have raised previously. Although we are allowing new people to come onto the system there is a need to move forward in regard to computerisation. I raised the issue of the system in Denmark where a person has a patient medication card just as each one of us has a Visa card. This can access one's bank account no matter where one goes. Likewise we should be working towards a system where every person would have a patient medication card. I realise this is being rolled out in cancer services but it is a long-term agenda. The person would go to the GP, present the card, the GP would provide a prescription, not by hand but by putting it onto the person's file. The patient could then go to the pharmacy, present the card and the pharmacist would access the information on the file. If the person is admitted suddenly to hospital all his or her medical records are on the card so a doctor in the hospital need not wait for four or five hours for that file because it is immediately available. Obviously, there must be security provisions but this is the way forward. When we encourage people to start up in this area we must ensure we also encourage computerisation in order to cut down the paper load involved in medical care.

It was interesting to look at the figures in regard to medical cards and see how the number of people with cards is growing. As of 1 January there were 1,694,063 people with medical cards and another 125,000 who had GP visit cards. A total of 1,819,720 people are entitled to medical care. We are moving close to a situation where almost 40% of the population will have either a medical card or a GP card. This emphasises the need for opening up this entire area and allowing more people into practice.

The figure I have for the number of GPs registered under the GMS scheme is 2,279. In real terms this is rather small when one thinks of the number of people with medical cards. I realise some of the practices in question would have more than one doctor but it is interesting that the number of card holders has grown in the past two or three years and will probably continue to grow in the coming years. It is important that the standard of care is maintained. This is one of the issues on which we must continue to improve. I know people can be critical of the services provided but the majority of GPs provide an excellent service and system of cover. However, there are deficiencies in some areas of which we need to be conscious. As the primary care reimbursement scheme comes to €493 million a year, it is important we get value for money from it.

I have concerns about GP training. A training doctor at a hospital I know told me a young trainee inquired why he had to learn about stitching, a relatively small procedure, or work on weekends as he would never have to do these as a GP. There is a culture in general practice that it is a nine to five, five days a week job. It is necessary to get it across that a community GP scheme must be comprehensive - people do not get sick just between nine and five - and not depend on which part of the country or an urban area one resides.

I agree with the Minister's point during the Dáil debate on the legislation on the need for GPs to work together to provide a comprehensive service across a range of areas. He referred to a practice in Mallow where 17 GPs have come together to provide much more services than before at a local level.

I know of several GPs who trained for several years to be paediatricians, obstetricians and gynaecologists but did not finish their training. They have a wealth of experience which should be tapped into for the benefit of hospitals which may require temporary cover, say for a day.

I welcome this long overdue Bill which will provide a degree of competition in the GP sector and enable us to provide a comprehensive health service in communities.

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