Catherine Noone (Fine Gael) | Oireachtas source

I welcome the Minister of State to the House and I welcome the Bill. The Bill, as other Senators have alluded to, has caused considerable angst among the medical community prior to the agreement with the IMO, which I commend. From recent polls, it is clear that 80% of the public are behind the proposal. This Bill is the starting point for a new universal GP service. This first step will give an entitlement to a GP service without fees to all children aged under six. It is the first step in the Government's ongoing commitment to ultimately bring about a universal GP service without fees within its term of office and as set out in the programme for Government. It is one on which we need to deliver.

Many people have concerns around the introduction of this. Some of these have played out in the newspapers over the past year. One of my main sources of concern is that many GPs, including many of my friends, are leaving the country. It is not just GPs who are leaving. Consultants and junior doctors are also leaving. We need to urgently figure out why these people are leaving the country in a way that goes beyond anecdotal evidence and then address those factors. Is the reason financial? I think it is. Is it supply-based? Is it because of career path concerns or other reasons? Obviously, people reach decisions for a variety of reasons. It is not just GPs who are leaving. I would be very interested in hearing the Minister of State's comments because it is something that affects many of my friends and acquaintances. One matter that is of grave concern to me involved the sister of a friend of mine who left for Canada recently. She is not a GP and I suppose I am digressing from the issue but it is relevant to the overall issue. She was told by a would-be mentor in the department to go and stay away for at least ten years because things would not improve. I would be interested in hearing the Minister of State's comments to counter that argument when it comes to that particular difficulty we are having in our medical services.

The framework agreed with the IMO is welcome and removes the most significant stumbling block to the rolling out of this service. There had been well-publicised concerns from GPs about this but one underlying problem, which I am not sure has been addressed, has been the idea that if a service is free, people are inclined to use it when it is unnecessary. It would seem to me that even if we were to introduce a nominal fee of say €5 or €10, it might prevent this from happening. In saying this, I do buy into the argument that once a charge is introduced, it could be subject to being increased so I would be interested in hearing the Minister of State's comments on that.

The medical card issue arose during the local and European elections. In my view, there is a lack of informed debate on the real cost of maintaining this system and how the system can be substantially funded.

There is also a lack of honesty about the figures. Nearly 2 million medical and GP cards are in circulation, covering more than 40% of the population. Under this Bill, 420,000 children will receive free GP care, and the 181,000 who already have GP cards or medical cards will be joined by a further 240,000 who will gain entitlement under this Bill. It is most welcome and will ease the pressure on parents, particularly those who are under financial pressure, and will lead to better health care overall from the point of view that people will not delay accessing our health services through their GPs in the first instance. Studies indicate that the number of GP visits made is related to price and that free GP access results in more frequent visits to the GP. However, all evidence shows that earlier detection and treatment of illness ultimately reduces both the long-term cost to the system and, hopefully, the impact on the patient.

The measure is not being funded as a consequence of savings implemented elsewhere in the health system and is an entirely separate budgetary measure. It will provide a GP service to approximately 240,000 children who currently must pay to see a GP. Providing access to a GP service without fees to all children aged five and under will mean that almost half of the population will have access to GP services without fees and will see us a long way towards implementing the Government's strategy.

I acknowledge the contribution of GPs to restoring our economy and the very significant role they play. GPs have experienced a reduction in fees paid under the general medical services, GMS, scheme. In 2008 they received €353 per patient per year, and this was reduced to €243 in 2012 and further in 2013. The overall figure the Government paid to GPs under the GMS scheme remained at €450 million as a result of an extra 600,000 people becoming eligible for medical cards. I welcome the Bill. The acceptance of the scheme by the GPs and ongoing dialogue is very important. I commend the Minister on his work in the area, to which he is very committed.