Sean Barrett (Independent) | Oireachtas source

I welcome the Minister of State.

I agree with virtually everything Senators Crown, Gilroy and Colm Burke have said. The general practitioner service is the part of the health service that works. In a situation in which well over 90% - I am sure the Minister of State can correct me on the number - of people who attend accident and emergency departments are never admitted to hospital, does this not illustrate the scope for developing the GP service? I would like to see such a service provided in the evenings and at weekends because, after all, people also get sick at those times. I also would like to see group practice GPs, in which perhaps three or four people got together. If one had been involved in sports in college, he or she could specialise in that, while another may have an interest in paediatrics and so on. There is scope in this regard because once one gets inside the door of a hospital, whether into the accident and emergency department or certainly if one gets upstairs to the beds, one's costs will be far higher than the €55 the Minister of State mentioned on Second Stage as being the cost of a GP visit.

Senator Crown has extolled the virtues of the doctor being fully trained. He or she has low overheads and it is not a two-tier system. Moreover, the GP service does not have the edifice complex with which the Minister, Deputy Reilly, and the Minister of State must deal in the Irish health service, whereby we keep on closing hospitals and opening new ones. It seems to be never-ending and the arguments always are about buildings and edifices, not about patients. It is important that the general practitioner service be kept onside. I do not know whether there have been developments in respect of the National Association of General Practitioners. There appear to be some differences of opinion between that association and the Irish Medical Organisation, IMO, which appears to be the negotiating body. However, as Senator Healy Eames has noted, society as a whole, including all Members, would not like to have any GPs who are unhappy in this regard. This is an important part of the health service and Members wish to ensure the Government is negotiating with people who represent the entire sector.

As for the GPs, if I take the 410,000 children who are aged between zero and six, according to the Start Strong report, the Minister of State's estimate was that approximately 40% of those children already have cards. The Minister of State may have more up-to-date figures in this regard. Consequently, this measure pertains to the remaining 60% of that 410,000 population. As I perceive it, this will change the relationship between 250,000 patients or customers of GPs and they are entitled to be concerned. They appear to be quite happy, and on Second Stage I mentioned the income distribution statistics to the Minister of State. I appreciate that in a policy sense, the Minister of State wishes to have them included but under no measure of poverty do the aforementioned 250,000 people count. They are not in DEIS schools, they are not in consistent poverty and they do not qualify under the survey on income and living conditions, SILC, study. Nevertheless, it has been decided politically that this relatively well-off section of the population of 250,000 people are to have their relationship with their GPs changed. While this is a relationship I consider to be working, it is getting the intervention of the bureaucracy, the kind about which Senator Crown has expressed concern. In a health service that still employs approximately twice as many bureaucrats as it does doctors and dentists, I share that concern. The system is working well and there is no need to have layers of bureaucracy involved. If one wishes to help people on low incomes, that should be done directly through the medical card system by extending eligibility as the circumstances of the country permit.

However, I refer to the suggestion that these additional 250,000 people, whose parents currently pay the €55, can be catered for with €37 million, which is the figure the Minister of State mentioned on Second Stage. This does not stand up because the last time something like this was done, I believe most ill-advisedly, was when medical cards entitlements were extended to the over-70s. The first budget was €19 million for 39,000 beneficiaries but the outturn, as the Brennan commission report stated, was €55 million for 77,000 beneficiaries. Moreover, it was necessary to introduce a gold card system because some private patients were worth more to the doctors concerned than was on offer from the State by giving them all medical cards. Consequently, on the track record, I worry about the cost. Had I tabled an amendment today, it would have been to propose the capping of this programme at the €37 million figure mentioned by the Minister of State. At present, the General Medical Services system costs €2.8 billion and to extend it by quarter of a million people for €37 million will require some miracle of loaves and fishes. I worry about that aspect.

I also worry about what it is doing to the GPs. I prefer the system in which they themselves provide the premises and the involvement of building sections is avoided. When the arguments about Balbriggan, medical centres and so on arose, my question was to ask why build them at all. I was not interested in whose constituency they were but in why they were necessary when this was a job the GPs had been doing well for decades past. If one wishes to help people with low incomes or if one wishes to extend eligibility to other people, a goal I do not share in this instance, one should not undermine a system that has served us well in the face of massive costs in accident and emergency departments and the unnecessary frequenting of such units. The Minister, Deputy Reilly, has referred in this House to the deskilling of GPs because a hospital culture has been built in which people do not think it is the practice of medicine unless one gets a letter to attend a hospital. People have stated that sometimes GPs are virtually confined to letter-writing, that is, to an employer to state someone is sick when he or she is not or to a consultant when the treatment could take place in the GP surgery. I would like to see that service developed and the freedom to comment, which doctors always have had our society and which is covered by Senator Crown's amendments, retained and enhanced. I worry about turning GPs into civil servants, given the problems we have had in the health service heretofore. Again, however, the Minister of State is most welcome and I value the manner in which this debate is organised, as it allows Members to refer to so many aspects that I hope will be of assistance to the Minister of State in what I definitely hope will be an ongoing role in developing the GP service. I thank the Minister of State in that regard.