Fidelma Healy Eames (Fine Gael) | Oireachtas source

The Minister of State, Deputy Alex White, is very welcome. I thank him for attending in person to address this matter because it is directly related to his brief. I wish to raise the need for the Minister for Health to outline the reason he will not enter negotiations with general practitioners on the delivery of free general practitioner care for those under six if he wants reliable universal delivery of care across the country.

I am sure the Minister of State is well aware that I stood for election on a platform of reorienting care from hospitals to the community. I refer to complete reliance on primary care. From my having built a case in the past for a primary care centre in Oranmore, which case was dumped down the list by the Minister for Health, Deputy James Reilly, over 12 months ago, I learned there is no hope unless there is a general practitioner on board.

Just over a week ago I listened to approximately 200 general practitioners in Galway. I am not here to advocate for general practitioners but for families, including children under six. From what I have heard, the contract the Minister for Health is now presenting to general practitioners will fail. I do not want that to happen and I am sure he does not either. The main reason the initiative will fail is that the contract has not been drawn up in collaborative negotiation with general practitioners.

The Minister of State will know there has already been quite a strike at the incomes of general practitioners by way of the FEMPI cuts and the over-70s deal. This has led to a cut of approximately 35% to 40%. From all the evidence I have heard, I note this is the one area of the health service that is working well. Expenditure on general practitioner and primary care amounts to between 3% and 4% of the national health budget.

At the meeting I attended, a doctor said that, of the 100 patients he treats, 1.3, on average, go to hospital, and 98% are taken care of by him. That is a fantastic record. Therefore, let us be really careful not to break something that is not yet broken and move carefully. I will support universal health care for those under six if we can make it happen. However, I will not support it if it is only for show. From what I have heard so far, show is what will be evident because few, if any, general practitioners are prepared to sign up to the contract. The issue is really the general practitioners' right to negotiate terms and conditions of their contracts.

The Government, represented by the Minister, Deputy James Reilly, is saying general practitioners are all independent contractors under competition law. The Government suggests general practitioners are working in a pure market and it asserts its right to design and price a contract with minimum or no consultation. It denies the right to negotiate, and this is the fundamental problem.

I am so serious about health care in this country, as is the Minister of State. Let us not let it fall owing to our not having the humility and courage to negotiate with general practitioners. Let them design the flaws if there are to be any. At least in that case the general practitioners will feel they are involved. If it means amending competition law, let us do so. It is clear that the under-sixes contract designed by the Department is flawed beyond recovery and that very few general practitioners will sign up to it. This was also the case regarding the cervical screening programme. It eventually required line-by-line negotiation to deliver a proper contract. The Minister of State will recall that himself.

There is a shortage of general practitioners. In rural areas, it is now almost impossible to get one, which is incredible. There is no market as there are fewer and fewer general practitioners available to take up posts. I will give the Minister of State a few examples. In Ballaghaderreen in County Roscommon, a list of 1,200 patients in the Westdoc co-operative could not attract one candidate. A list of 800 patients became available at the same time in Ballyhaunis and there were only two candidates. Eventually, the unsuccessful candidate in Ballyhaunis took the post in Ballaghaderreen. In Galway, the HSE dissolved a list in Dunmore after its having made it so unattractive as to attract no candidates, thus reducing the number of general practitioners in the area providing services. There was a similar case in the Mervue area of Galway city.

The HSE has been attaching many onerous additional requirements to contracts, such as the requirement to make a future commitment to move one's practice, despite the fact that general practitioners are expected to invest in their practices. This is ludicrous. The general practitioners borrow and invest heavily. Some young general practitioners, from whom I heard at the meeting in Galway, now regret their decision. This has happened in Frenchpark, Dunmore and Williamston, for example.

There are 264 general practitioners over the age of 64 in Galway. Some 1,100 Irish general practitioners have become principals in the NHS in the past four years, which amounts to 50% of the wholetime general practitioners in this country. The HSE recruitment policy is failing abysmally and the under-sixes contract has hardened the view of many young general practitioners that this is not a doctor-friendly country. They are leaving in their droves. Let us stop and think about this. It is deplorable for the general practitioners' families and themselves. It is particularly deplorable for the country. The Minister of State and I know the State has invested heavily in the young general practitioners' training. This must be watched and reversed. We need the doctors here; we need our own people.

The under-sixes contract represents everything that, to me, appears to be worst in the HSE. It is centralised and rigid and amounts to intrusive control of everything from data to the right to professional advocacy for patients. Does the Minister of State believe it is correct that there is gagging of general practitioners? I do not. We are trying to bring whistleblower legislation into effect but the gagging of general practitioners looks like the quelling of whistleblowers to me.

The ultimate effect will be that patients will find it increasingly difficult to gain access to quality general practitioners in the very near future. This is no way to start our journey to universal health insurance. I want from the Minister of State this evening a commitment to enter negotiations on a new general practitioner contract. If that means amending the Competition Act, let us do so. I do not want to see us lose fine young general practitioners, nor do I want to see general practitioners put on the breadline. One general practitioner, Dr. Casey, spoke about trading recklessly. He said he has now an insolvent practice.

If this Government does not take this action it will be saying to me that this was nothing but an empty political promise and if it fails, the excuse will be to blame the doctors. I cannot stand over that. I am looking forward to the Minister of State's reply but we must find a way to work with our doctors and bring them on board if we are serious about delivering free GP care to those under six years of age.