Keith Swanick (Fianna Fail) | Oireachtas source

I welcome the Minister to the House. I have asked him here today to discuss the state of negotiations with general practitioners regarding a new contract, to outline a timetable for the reversal of cuts under financial emergency measures in the public interest, FEMPI, legislation to general practitioners; and to ask what contingency plans are in place to ensure the retention and recruitment of GPs, especially in rural Ireland.

GPs have suffered cuts of up to 38% under the FEMPI legislation and meanwhile patients with medical cards and GP visit cards have increased to almost half the population with the introduction of the under-sixes and over-70s schemes.

The FEMPI legislation was introduced as an extraordinary financial measure but it is now having dire consequences for the healthcare sector as a whole. FEMPI is a key factor in the high rates of emigration of GPs as the profession becomes untenable and unviable in this country. FEMPI cuts have destroyed general practitioners practices especially in remote areas and deprived urban areas. FEMPI has not affected Ballsbridge in Dublin 4 but it has in those two types of locations I mentioned, where the majority of patients have medical cards. For example, in my own rural area of north west Mayo, GPs work up to an hour and a half away from a hospital. GPs face social issues such as drug abuse and addiction problems in deprived urban areas. FEMPI has been damaging in those two types of areas. It is not possible to take €2 billion out of general practice without having a devastating effect on the entire health service. We know that every €1 that is spent in primary care saves approximately €5 in the rest of the health service.

FEMPI has, in effect, halved the funding available per patient in general practice over the past ten years. The cuts have reduced the capacity of family doctors to provide a safe service for patients. They cause thousands of patients to attend emergency departments unnecessarily every week. The health service cannot function properly until general practice is fixed. I wish politicians, and the Minister in particular, would accept this. I am not making this up, it is a hard, cold fact. We need general practice fixed. GPs are the gatekeepers of our health system and we need them for our total health system to function properly.

General practice is viewed as unviable by newly-qualified doctors. We need the FEMPI cuts reversed and a new general medical services contract.

There are 63.1 GPs per 100,000 people in this country. Those figures are well below the international best practice of 80 GPs per 100,000 people. A survey by the Irish College of General Practitioners, ICGP, found that upwards of 40% of GP trainees indicated they would emigrate after graduation. We must stem the tide of emigration or the manpower crisis will continue and both GPs and patients will continue to suffer the effects.I support the GPs' campaign for better terms and conditions through the undoing of FEMPI. Many hundreds of GPs will march on the Dáil today. As I can attest, if the current situation is allowed to continue, practices will struggle to remain open and to keep GPs employed, especially in rural areas, which is my main concern.

Dr. Padraig McGarry, chairman of the Irish Medical Organisation, IMO, GP committee, said there is a threat that some GPs will not be replaced and that areas in rural Ireland, particularly west of the Shannon, will not be able to attract GPs. A decade ago positions in rural practice often attracted up to 30 applications. In my own practice in Belmullet, when I applied for the job, there were 12 applications. Today, substantial practices struggle to get just one applicant and, in some areas, there is no interest at all. Young GPs are not prepared to come in under the present circumstances of excessive hours and poor supports. There will be situations where elderly, sick and vulnerable patients have to travel unjust distances on a poor road network, or depend on a public transport system that might not be efficient, to see a GP because their local GP practice has closed. They will be met with different locums week after week, which is not fair on the elderly patient, who has to try to strike up a rapport with a new GP on an ongoing basis.

We need to encourage young GPs to come to rural areas, not dissuade them. A new contract for GPs will be an important step forward in addressing this issue but while GPs have been working for years to get the basis of a new contract, little or no progress has been made. I implore the Minister of State to redouble efforts in this regard and I look forward his response.