Alex White (Dublin South, Labour) | Oireachtas source

I do not propose to accept the amendment. There is no intention to roll back or renege on the position as set out in the 2012 Act, nor will it be the effect of section 7(9). I understand and accept the argument Senator Barrett made yesterday on the opening up of the system. He made some compelling points with which I agree and which were properly dealt with through the legislation to which I referred. There is no question of that Act being rolled back or in any sense reversed by anything in this Bill.

The Senator is concerned that the section may, even inadvertently, repeal or roll back the 2012 measures. I understand his remarks to suggest that it is almost the intention to do so. I assure him that this does not constitute a backsliding from the measures taken in 2012 to open up general medical service contracts to any fully qualified general practitioners. The provisions of the Health (Provision of General Practitioner Services) Act 2012 are not affected by the subsection. As I stated, the 2012 Act opened up access to GMS contracts to all fully-qualified and vocationally-trained general practitioners, subject to general suitability criteria. No limits have been set on the number of GP contractors.

The Senator will be aware that previously there were three routes for entry into the GPS scheme. These were: where a vacancy arose due to the retirement, resignation or death of an existing GMS doctor; where a new GMS panel was created in response to an identified need for an additional doctor in an area; or where a GMS doctor obtained approval from the Health Service Executive for the creation of an assistant with a view to partnership within his or her practice. Previously the HSE was required, before filling a vacant GMS panel or creating a new panel, to take account of the potential viability of the panel and the viability of existing GP practices in the area in question. Under the 2012 legislation, new GMS contract holders are free to establish their practice in the location of their choice. There is a caveat that, once established, any GP contract holder who wishes to move location will only be able to do so with the prior approval of the HSE. This provision is designed simply to ensure continuity of GP care for patients. To date, 114 general practitioners have obtained a GMS contract under the Health (Provision of General Practitioner Services) Act 2012. There are in the region of 2,400 GPs with GMS contracts in total.

I understand the Competition Authority has expressed the view that the new arrangements are having a very positive effect. The authority is reported to have seen evidence of doctors advertising their services and prices, as well as greater moves in terms of innovation in pricing among GPs, which is also a positive change. The new open contractual arrangements between general practitioners in the GMS scheme are not affected by section 7(9). The subsection deals with the relationship between the patient and general practitioner. The language ensures that as far as practicable the HSE will arrange the general practitioner service with the GP of choice by the individual. However, we cannot guarantee that the individual will always get the GP of his or her choice. This is the reason for the provision. It could happen that the general practitioner of choice is unwilling to take on a new patient because he or she already has too many patients. In general, GPs are not supposed to have more than 2,000 GMS patients.

I am concerned that the Senator's amendment would inadvertently engender an inflexibility and impracticality in the delivery of general practitioner services by the Health Service Executive and general practitioners. It is for this reason alone that I do not propose to accept the amendment.