Fidelma Healy Eames (Fine Gael)
Link to this: Individually | In context | 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.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I thank Senator Healy Eames for raising this issue. The Government's vision for primary care is the development of a single-tier system where access is based on medical need and not on ability to pay. The Government, therefore, committed to introducing a universal GP service without fees, on a phased basis, within its term of office. The orientation of health systems towards primary health care and general practice has advantages in terms of better population outcomes, improved equity, access, continuity of care and lower cost.

As announced in the budget, the Government has decided to commence the roll-out of universal GP services by providing all children under 6 years of age with access to a GP service without fees. The decision to commence the roll-out with this age cohort is in accordance with the recommendation in Right from the Start, the report of the expert advisory group on the early years strategy. Universal screening and surveillance services are already made available for children in this age cohort. Evidence suggests that a high-quality primary care system with universal access will achieve better outcomes for young children. The Government is providing new, additional funding of €37 million to meet the cost of this measure. The implementation of this measure will require primary legislation which is expected to be published within days. The necessary administrative arrangements will be made when the specifics of the legislation are published.

The introduction of this service also requires a new contractual framework to be put in place between the HSE and individual general practitioners. In this regard, I emphasise that a draft contract is currently the subject of a consultation process. In excess of 280 responses were received by the HSE during the consultation process. These responses are currently being examined and a report will be published in due course. While there has been some negative reaction to the draft contract, I am pleased that the Irish Medical Organisation, the primary representative body for general practitioners, has confirmed that it is supportive of Government policy to introduce GP care free at the point of access, albeit conditional on the provision of adequate resources and full and meaningful negotiations with the IMO. I welcome this response and I have assured the IMO most recently in my letter dated 26 March, that the Department and the HSE are fully prepared to engage meaningfully with it and are prepared to negotiate with it on all aspects of the scope and content of the proposed contract. I have also explained to the IMO that there will be an opportunity for its input on the fee structure which will be addressed by means of a complementary consultation process. However, the ultimate setting of fees must remain a matter for the Minister for Health.

I trust that the IMO will accept my invitation to commence negotiations with the Department and the HSE. This will afford the IMO the fullest opportunity to obtain clarification from the Department and the HSE on any aspect of the draft contract and to raise any other issues which it may have regarding it. I am confident that a process of open discussion as advocated by the Senator has the potential to significantly enhance the draft contract for patients, general practitioners, the HSE, the Department and the people of Ireland, thus helping to progress our common goal of free GP care at the point of access.

Fidelma Healy Eames (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State. I am delighted he has stated he is open to full and meaningful negotiations with the IMO because that is what the doctors are looking for. I stress that they are not looking for consultation. I accept there is no doubt that we will improve population health if we have universal health care but only if we have the doctors to serve the patients. I take from the Minister of State's reply that he wants the doctors to co-operate. In the UK NHS system it could take seven days to get an appointment for free GP care for a child. That is not what we want to happen here because it would make a nonsense of the plan. I will take the Minister of State's reply in good faith. That information certainly had not trickled down to the doctors in Galway a week ago. I look forward to hearing that meaningful negotiations took place.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

For the information of the House it is important for me to emphasise again that on three occasions in recent weeks I have extended an invitation to the IMO and to the doctors' representatives to meet me in this regard. On 27 February 2014, I wrote to the IMO and I wish to put details of that letter on the record of the House:

The Department and the HSE are fully prepared to engage meaningfully with the IMO. We are ready to meet with you, and we are prepared to negotiate with you on all aspects of the scope and content of the proposed contract. I should state, however, that the ultimate setting of fees must remain a matter for the Minister for Health, though there will be an opportunity for your input on this aspect, and on the fee structure, which it is proposed to address by means of a separate consultation process....

Accordingly, I am now formally inviting the IMO to meet with the Department and the HSE to commence the process, and to afford you an opportunity to elaborate on your submission of 21st February. My preference is that this meeting should take place during the week beginning 3rd March 2014 but a mutually agreeable date can be arranged if this week does not suit....

It seems to me that we can work together to seek a consensus on the many important matters of mutual concern, and it is my genuine wish that we should proceed in that spirit.

I am confident that we can make good progress in achieving our common goal of GP care free at the point of access and therefore again invite the IMO to commence negotiations with the Department and the HSE.

Fidelma Healy Eames (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Why does the Minister of State think this has not happened?

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I cannot say that. I wrote these letters to the IMO. It is not for me to speculate as to why-----

Fidelma Healy Eames (Fine Gael)
Link to this: Individually | In context | Oireachtas source

It does not sound good.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

These are the letters.

Fidelma Healy Eames (Fine Gael)
Link to this: Individually | In context | Oireachtas source

It does not sound good if nothing has happened.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I was asked to deal with the issue of the preparedness for negotiations and I think I have dealt with it.