Seanad debates
Wednesday, 6 February 2019
Nithe i dtosach suíonna - Commencement Matters
General Practitioner Contracts
10:30 am
Keith Swanick (Fianna Fail)
Link to this: Individually | In context | 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.
Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank the Senator for raising this issue. I assure the House that the Government is committed to engaging with GP representatives on the development of modernised GP contractual arrangements. Discussions with representatives were progressed on a wide range of items throughout 2017 without reaching a conclusion. A new phase of discussions commenced in May 2018 based on the mandate set by Government in March. Officials from the Department and the HSE met IMO officials, as the established GP representative body, at the beginning of May to set out the State’s position in regard to the GMS contract and to progress this important issue.
The State side set out the mandate agreed by Government under which the consultations were being conducted and the package of measures to be agreed. The Department subsequently wrote to the IMO, at the organisation’s request, setting out these proposals formally. The IMO responded to the Department by letter on 20 July. Talks resumed in October 2018 and there was intensive engagement, particularly in the weeks leading up to Christmas. While some progress was made, a number of outstanding issues need to be progressed before any agreement can be secured.
The State’s negotiating team is keen to bring a renewed focus to the engagement with the IMO and talks are continuing in an effort to bring matters to a conclusion. I look forward to positive and productive engagement with all parties concerned. Agreement on the delivery of service improvements and contractual reform would facilitate a substantial increase in the resourcing of general practice on a multi-annual basis. In line with the long-established approach to such processes, and by agreement of the parties concerned, I am not in a position to give further details while engagement between the parties is under way.
The Government is aware of workforce issues facing general practice, including the influence of demographic factors, and has implemented a number of measures to improve recruitment and retention in general practice. GP training places have been increased from 120 in 2009 to 202 places in 2019. The objective is to continue to achieve annual increases in the number of training places available while ensuring all places are filled.
The entry provisions to the GMS scheme have been changed to accommodate more flexible GMS contracts and the retirement age for GPs has been extended to 72. An enhanced support package for rural practices has been introduced, with improved qualifying criteria and an increased financial allowance of €20,000 per annum. Some 257 GP practice units, encompassing 347 individual GPs, are now in receipt of financial supports under this framework, a significant increase on the 167 GPs who received a rural practice allowance prior to the introduction of the 2016 measures.
The Government remains committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services and that general practice remains an attractive career option.
Keith Swanick (Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I note the Minister of State did not comment on any possibility of reversal of FEMPI, which I mentioned in my opening contribution. There seems to be an air of secrecy regarding the new contract, which is a cause of deep frustration for many GPs throughout the country. Why was the National Association of General Practitioners, NAGP, excluded from the contract discussions, bearing in mind it was part of the discussions in 2017? Will it be a totally new contract or is it just intended to amend the current contract?
Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am not directly involved in the negotiations; the Department and the HSE are involved. However, I will ask the Minister, Deputy Harris, to address the Senator's two questions on the involvement of the NAGP in the talks and on FEMPI, which is more a matter for the Minister for Finance.