asked the Minister for Health if he will make general practitioners more aware of the financial incentives to improve their surgeries so that they can undertake many routine tests and thus relieve much of the pressure on hospitals; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Financial Incentives for General Practitioners.
11.
Under existing agreements with general practitioners in the GMS scheme, health boards may give grants towards the provision of new practice premises or for the improvement or extension of existing premises. In assessing applications for grants the health boards will have regard to the size of the doctors' list of patients, the nature and extent of existing accommodation and alternative facilities already provided by the health boards in the area.
On the matter of the transfer of routine tests and treatments from general hospitals to the general practice environment, I am confident that the new arrangements for doctors participating in the GMS scheme, due for implementation on 1 January 1989, contains the necessary structures and incentives to support such transfers, where appropriate.
First, would the Minister agree that in addition to the grants available through the health boards, the tax incentives available through the tax system are not widely known by GPs and that if they were more publicised many GPs might be more willing to improve their facilities? Secondly, would the Minister agree that certain tests, for example, cardiographs, blood and chest tests could be carried out in a doctor's surgery for about 20 per cent of the cost of doing the same tests in hospital?
In relation to the first part of the Deputy's question I would not accept that members of the medical profession would not be aware of their rights under the tax code.
The Minister might be surprised.
In relation to the second question I agree that there is a number of procedures which in the interests of patients should be carried out at general practice level and would also be economically worthwhile from the point of view of the use of the hospital resource, including the tests referred to by the Deputy.
Can the Minister clarify, under the new GMS contract which he proposes to operate from 1 January next, how the £3 million per annum which is allocated for extra payments to doctors will be spent and whether diagnostics such as those referred to by Deputy Harney would fit into this category for those payments? Would he clarify what the £3 million will be spent on?
I must dissuade Members from extending the scope of this question.
It arises out of the Minister's reply.
While I do not have the specific details of how the £3 million will be spent I can say that there will be investment to provide additional resources for the employment of support staff, in practice, for continuing education to update skills and for the purchase of appropriate equipment. A committee are sitting at present under the chairmanship of Professor Sexton of the ESRI to look at what tests might be appropriate to give a special fee to the practitioner which would have the effect referred to earlier by Deputy Harney, of having tests carried out at general practitioner level rather than at the hospital.
Would the Minister agree that there is a growing tendency for doctors to carry out tests to avoid litigation and that the desirable practice of carrying out more procedures in the surgery will not be achieved without addressing the problem of insurance and litigations?
No, I would not accept the latter part of the question. I believe that doctors will decide what they are competent to do in their own surgery. There is scope for a lot of tests to be carried out in the doctor's surgery which are not carried out there at present. I share the concern of Deputy Howlin that doctors are becoming more conscious of litigation and that there is quite a lot of investigation carried out that may not necessarily be in the best interest of medical practice as a whole. This is something to which we must address ourselves but I am not sure there is any good answer to it.