Colm Burke (Fine Gael)
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I thank the Minister of State, Deputy Kathleen Lynch, for making time available to deal with this matter, which relates to the new contract for GPs. It is an urgent matter in that many GPs are under pressure. Things have changed quite substantially during the past four to five years. While GPs have been able to carry them for the last four to five years, the additional costs they have incurred and the drop in their incomes cannot continue ad infinitum. I know a new contract is being negotiated but it would be helpful for the House if we were made aware of what progress has been made. We need this information, particularly in respect of rural practices. One GP told me that €200,000 was coming into the practice four or five years ago in respect of the provision of care to medical card patients.The number of medical card patients in his practice has increased substantially but the amount of money he is getting has decreased to €120,000. That represents a drop of over 40%. Most GPs are experiencing similar reductions at a time when they have to maintain rent payments or service mortgages for their premises and meet the cost of rates, insurance and wages. In addition, the cut in funding for practice nurses has led to a reduction in the number of hours for which GPs can afford to pay such nurses. It is extremely important for us to get this part of the health system right. The sooner we do so, the better. GPs provide a comprehensive service. They are extremely committed to their patients. They do everything possible to provide the best standard of care to their patients. It is in that context that I am raising this matter and calling on the Minister of State to bring us up to date on the current status of the negotiations.

Kathleen Lynch (Cork North Central, Labour)
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I assure the House that the Government is strongly committed to the future of rural Ireland. We recognise the contribution that rural communities have made to overall national economic development and the development of local areas. Our vision is of rural areas that are vibrant, inclusive and thriving economically . People in rural communities should experience a quality of life that is at least as high, and probably better in several respects, as that experienced in urban areas. The Government is committed to ensuring patients throughout the country continue to have access to GP services, especially in remote rural areas. We will ensure general practice is sustainable in such areas into the future.

The HSE, the Department of Health and Irish Medical Organisation are engaged in a comprehensive review of the general medical services and of other publicly-funded health sector GP contracts. One of the issues encompassed by this review process is support for general practice, especially in remote rural areas. While I do not propose to comment on the detail of the ongoing negotiations, I wish to depart from the prepared script by saying we are looking at the possibility of practice nurses being hired by the State so that GPs are no longer responsible for their recruitment. I think this is one of the issues that will be discussed in the negotiations, even if it is not completed or agreed on. Under the current general medical services contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual allowance of just over €16,200. They also qualify for more favourable subsidies towards the employment of staff, including practice nurses and secretarial support. More advantageous supports for locum costs for leave are also payable.

The HSE has recently produced revised rural practice allowance guidelines for remote rural areas. The purpose of the new guidelines is to ensure consistency, transparency and fairness when decisions are made about the relevant discretionary provisions of the general medical services contract as they apply to rural GP practices. The guidelines also provide for a level of flexibility in considering applications from GPs which is greater than that provided for in the original governing circular. The guidelines also provide additional options to support GPs. From time to time, HSE local offices offer other incentives to attract GPs into rural areas, such as access to HSE facilities. Additional contracts are also offered, such as contracts to provide medical officer services to nursing homes.

I am aware that some isolated rural areas and deprived urban areas, often with limited private practice opportunities, may find it difficult to attract GPs to fill vacant posts. However, I have been assured by the HSE that where a general medical services GP vacancy arises, it takes the necessary steps to ensure continuity of service to general medical services patients is maintained. On 1 November last, there were just 20 general medical services lists out of a national total of more than 2,400 such lists without a permanent GP in place. Eight of the 20 vacancies are in rural areas with populations of less than 1,500. The full range of GP services continues to be provided to the patients concerned through a locum GP or a neighbouring GP. A key objective of the engagement that is taking place with the Irish Medical Organisation at present is to achieve revised and modernised contractual arrangements which support the sustainable delivery of enhanced GP services in local communities. These services constitute a key element of the range of public and privately provided services, including health and social services, that people need so that life in rural areas remains attractive and sustainable for them at all stages of their lives.

Colm Burke (Fine Gael)
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I thank the Minister of State for the comprehensive reply. I know the negotiations are ongoing and I understand progress is being made. Do we have any guideline on whether any aspect of the contract can be concluded? I do not want to tie down the Minister of State on this. I suppose the big problem is that GPs are dealing with such uncertainty at the moment. Is there any way that a timeline might be set so that some part of the contract, at least, can be finalised and put into place? I am aware that the contract which is currently in place is over 40 years old. I understand that the process of negotiation is very detailed. Is there anything we can put into place to encourage and help GPs in rural practices?

Kathleen Lynch (Cork North Central, Labour)
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This is a very extensive process because of the generalist nature of the work of GPs, which has changed dramatically in recent years. Things such as the minor surgery piece and the chronic care cycles will be rolled out into primary care and GP services. It is an incredibly wide brief. On the other hand, we do not have control of all of this process. The negotiations between the Department and the Irish Medical Organisation are just one aspect of it. As we know from the work that was done on the contracts for those under the age of six and those over the age of 70, these matters have to be referred to the GPs and the medical community within primary care. We have no control over that. It is hoped that we will get it done as quickly as possible. Much of the preliminary stuff was done during the negotiations on the contracts for the provision of GP services to those under the age of six and over the age of 70. A great deal of the talking was done at that time, even if no agreement was reached. The needs were very clearly laid out. We hope the negotiations will be concluded as quickly as possible. We will not have control of the process after that point, however. That makes it very difficult to say when this process will be concluded. There may be elements of it with which the GP community does not agree. In such circumstances, we will have to come back into negotiations again. We will do what we can as quickly as we can. There will be no delay.

Colm Burke (Fine Gael)
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I appreciate what the Minister of State has said.