Sean Barrett (Independent)

I welcome the Bill and endorse what Senators MacSharry, Colm Burke, Crown and Kelly have said. The Bill has been recommended by the troika. When the troika visited Trinity College at 9 a.m. on a Monday morning - we tried to notify as many Senators as possible - one of its members suggested that the GP fee in Ireland is twice what he pays in Brussels. This the costly system we are now dismantling. Incumbents generally dislike competition and they tend to lobby Governments to protect their privileges. As Senator Colm Burke pointed out, some of that lobbying turned what the Minister described as a choice of doctor scheme into a highly restricted choice of doctor scheme that would not have received the approval of the Competition Authority.

We should wait to see how the restrictions on locality and the decision making on the viability of practices operate in practice. We may find that new GPs will locate in areas that are not well served at present. The two occupations are not comparable but under the judgment of Mr. Justice Roderick Murphy on taxi deregulation, operators are entitled to enter a sector once they possess the necessary skills and training and the public is entitled to the services of such persons. The biggest increases in the opened up taxi market occurred outside Dublin. New producers can do lots of things when the market is not restricted. As we have 24-hour shops and petrol stations, we should also have 24-hour GP clinics. The open market will facilitate that. If certain kinds of GPs are needed in Temple Bar and other areas which are mainly frequented at night, a service will be established to deal with whatever medical needs arise. The golfing world that Senator MacSharry mentioned was too comfortable. The new people will follow where the need for their services exists.

I hope there will be a big reduction in the cost to the taxpayer because one hears already of examples from Killarney that where extra doctors move in the cost is being reduced. We should look for that also. At the end the Minister mentioned the budgetary implications, which could be very positive if the Department can negotiate at the new rates that will be available when all these extra people enter the market.

At a seminar organised by Pfizer approximately a year and a half ago when the Minister was the Opposition spokesperson and I was just an ordinary economist in Trinity College, we discussed the deskilling of GPs. Is a GP just to be a person who writes a letter to employers stating that an employee is sick when all three parties to the transaction know he is not sick, writes letters to pharmacists called prescriptions and writes letters to consultants called referrals? As Senator Crown has said even a highly experienced GP might send a letter to a relatively junior person in a hospital. We should try to relocate many of the functions of medicine away from outpatients, where I gather 95% of patients are never admitted and the cost is two or three times the cost of going to a GP, and certainly away from inpatients where costs of approximately €1,000 are run up. If we can put the GP at the centre, as the Minister intends, there are substantial possibilities.

I favour not just competition among GPs but also among health insurance companies. I was hoping that competing health insurance companies would be able to state they did not cheat by taking on only young people, but got better deals. This brings me to the Milliman report, which I am sure the Leader has discussed with the Minister. While we could have a separate debate on that report, it refers to patients being kept in hospital for 10.6 days for a procedure which should take 3.7 days in an alternative system and accumulates an enormous cost for the State.

The health service doubled its staff between the mid-1980s and 2007 when it peaked at 110,000 people. There has been too much bellyaching about a 2% or 3% reduction now. The real question is how it got from 55,000 people to 110,000 before this problem was finally addressed in 2007.

Regarding means testing, in his book, Professor Drumm states his hope that by centralising medical card administration it could be done by 130 staff as opposed to by 430 when it was done in separate offices. Given the failure of the Department of Social Protection and the Revenue Commissioners to get their act together on pensions, should all means testing not be done in one central location rather than having means testing in multiple locations? With higher education grants it is extremely strange how easy it is for the self-employed to get student grants and virtually impossible for PAYE people to get them. Means testing and medical cards are part of a wider problem.

Some GPs were required to wait until 2013 before treating any medical card patient and I am glad the Minister has done away with that.

The change in rules on admission to medical schools makes it more difficult for women in particular to study medicine. In our college we have people with the maximum 600 points from their leaving certificate examinations who, because of the HPAT could not have gained entry. Looking back on that, if all the people with high points - 500 or more - who had applied to study medicine had been allowed in, we would have a far better health service today. Keeping out talented young people from being GPs - which the Minister is correcting with the Bill before us - or from the study of medicine is not a good idea in terms of the health service we are trying to build up.

This is a great start and should lead to the development of group GP practices and transferring outpatient and even some in-hospital treatments to GP surgeries. The Bill represents a start and has already been commended by people from all sides of the House. Based on the economics of it, it seems to be the correct way to go and I compliment the Minister on the Bill.