Seanad debates

Thursday, 20 May 2010

General Practitioner Co-operatives

 

1:00 pm

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
Link to this: Individually | In context

I raise this issue relating to the MIDOC service in the midland region. MIDOC is an out-of-hours general practitioner service for the people of the midland region which has been in operation for ten years.

We in the Athlone area have no hospital — Portiuncula is 15 miles away and Mullingar is 28 miles away. We have no primary care unit. This week the HSE is closing our long-stay residential facility for the elderly. The HSE has reduced the number of hospital services for the elderly. This residential care centre has been reduced to 40 from 200. We have no health service whatsoever in the Athlone area, and now there is a threat to the MIDOC out-of-hours general practitioner service.

This has arisen because there are new tax rules being imposed by the Revenue Commissioners for locum doctors. Up until now, locum doctors were deemed to be self-employed and according to Revenue they are now PAYE workers. They have been recognised as being self-employed for over 100 years.

The MIDOC, with which I am closely associated because I worked in a medical practice, was budget neutral and may even have worked at a deficit. It provided excellent care for the 20,000 people in the Athlone area and now it is under threat.

I am asking the Minister what we will do. The accident and emergency service is under threat. There were ten people on trolleys in Mullingar Hospital the other night. Due to the moratorium, there are beds being closed every week in the midland region. I do not know what we will do. Where will it end? Ultimately, it is the responsibility of the Minister to ensure the future of a high quality general practitioner out-of-hours service for people considering that there is a consistent erosion of our services.

Portiuncula Hospital is under threat, Roscommon Hospital is under threat and Mullingar Hospital is under threat. Post mortem services were taken from Mullingar hospital last month and sent to Tullamore. Recently, there was a case where a post mortem could not be carried out in Tullamore and it was sent to Cavan.

I despair at what is happening to the people of the midlands and our health service. I ask that the Minister of State give me a reply that will satisfy the people in the Athlone area, namely that our MIDOC service will be retained at least to the same standard that we have had.

Photo of Dara CallearyDara Calleary (Minister of State with special responsibility for Public Service Transformation and Labour Affairs, Department of Enterprise, Trade and Employment; Minister of State, Department of An Taoiseach; Minister of State, Department of Finance; Mayo, Fianna Fail)
Link to this: Individually | In context

I am taking the Adjournment on behalf of my colleague, the Minister, Deputy Harney. I thank Senator McFadden for her remarks.

As she will be aware, the provision of general practitioner, GP, out-of-hours co-operatives is an essential part of our health service policy, particularly of strengthening primary care services and ensuring that, to the greatest extent possible, care needs are met in that setting.

Out-of-hours co-operatives allow GPs to manage the provision of urgently needed care for their patients in the evenings, at weekends and on public holidays. It also affords them reasonable off-duty arrangements. While there is no obligation on GPs to participate in these co-operatives, general practitioners contracted by the HSE under the GMS scheme must make suitable arrangements to enable contact to be made with them or a locum or deputy for emergencies outside normal practice hours.

Out-of-hours co-operatives are now in place in most parts of the country. The service can be accessed through a single lo-call telephone number in each HSE region and caters for both public and private patients.

The MIDOC GP out-of-hours service is a partnership initiative between the HSE and GPs in the midlands region. The service commenced in December 2002 in County Laois and now operates through five co-operatives, namely Laois, west Offaly, Athlone, east Westmeath and Longford. This accounts for 90% of the former Midland Health Board region. The only remaining areas in this region not covered by the service are Edenderry, County Offaly, Moate, County Westmeath and Tullamore.

There are currently 101 GPs participating in the MIDOC out-of-hours service, covering a population in excess of 204,000. There are on average 6,100 calls received monthly, 58% of which require follow-up at an out-of-hours treatment centre.

The co-operatives offer responsive, high-quality services from well-equipped modern clinical centres. All pay and non-pay costs associated with the day-to-day administration of MIDOC are met by the HSE. The budget for the MIDOC service in 2009 was almost €5.2 million, while the national budget for GP out-of-hours services in 2009 was in the region of €100 million.

The HSE published a review of GP out-of-hours services in March 2010. This was the first national review to be undertaken since the commencement of publicly-funded GP co-operatives in 1999. It provided an opportunity to consider the nine national GP co-operatives and the four extended-hours services.

The HSE national review of GP out-of-hours services makes 13 recommendations designed to strengthen and standardise the service across the country. These include a recommendation that the service be extended to cover parts of the country where there is currently no out-of-hours provision to ensure 100% out-of-hours coverage nationally.

I am pleased to advise the House that the HSE has assured the Department of Health and Children it has no plans to curtail or discontinue the MIDOC out-of-hours service.

Photo of Nicky McFaddenNicky McFadden (Fine Gael)
Link to this: Individually | In context

I welcome the Minister of State's response. Unfortunately there was no reference to the kernel of the issue which concerns the Revenue Commissioners and the tax issue. I ask if the Minister could reply on that issue. The towns of Moate, Tullamore and Edenderry are very anxious to be included in the system.

Photo of Dara CallearyDara Calleary (Minister of State with special responsibility for Public Service Transformation and Labour Affairs, Department of Enterprise, Trade and Employment; Minister of State, Department of An Taoiseach; Minister of State, Department of Finance; Mayo, Fianna Fail)
Link to this: Individually | In context

I will ask my officials to contact the Senator directly with regard to the Revenue question. The question of the provision of services is a matter for the HSE and also for local doctors. I will follow up on the Senator's query in that regard.