asked the Minister for Health if he will ensure, especially in city centre areas, that under the revised contract arrangements for payment of general practitioners under the General Medical Service that special payments will be made where there are higher visiting rates; or if he has any proposals to meet these specific area related problems.
Ceisteanna—Questions. Oral Answers. - GP Rates.
11.
The general medical services scheme was negotiated with the Irish Medical Organisation under the independent chairmanship of Mr. John Horgan, Chairman of the Labour Court, and, in my view, represents a sound and viable basis for the provision of services to all eligible patients.
The scale of fees underpinning the capitation method of remunerating participating doctors was drawn up having full regard to the demand placed on the scheme by patient groupings in the past. The new agreement also provides for a review, under an independent chairman after the first 12 months of its operation. I am confident that the review mechanism can deal effectively with any difficulty which may emerge.
Does the Minister accept that the scheme does not really recognise that some families do not have the capacity for home support in a time of illness, for example, single parent families, and that this is an acute problem in many city areas? Does he also accept that higher support rates will be inevitable? Does the Minister not accept that for GPs who have to attend to a population that has a disproportionate number of families in those categories there must be some recognition of that problem under the GMS?
The question refers to recognition by way of increased fee in the particular circumstances outlined by Deputy Bruton. As I have already said, the new scheme was negotiated with the Irish Medical Organisation and the scale of fees agreed. The negotiations were under the chairmanship of Mr. John Horgan, Chairman of the Labour Court. Obviously, there was agreement during the negotiations on the scale of fees.
With respect, is it not the Minister's responsibility to see that the service provided meets the needs of specific vulnerable groups? To say that two major sections came together in negotiation and settled on a deal does not give me reassurance that the needs of a particular vulnerable group are necessarily catered for under that agreement. Does the Minister feel that, for example, with a high number of single parents doctors are inevitably going to need to apply higher visiting rates in those areas because there is nobody else to fall back on?
The issue raised in the question is increased fees for doctors participating in inner city areas in particular. As I say, the fees and scale of fees were agreed between the IMO and management — health boards and the Department of Health. Deputy Bruton is raising a very fundamental issue of the provision of services. Certainly, I have responsibility and will discharge that responsibility to ensure that services are available. There should be no change in the availability of services to any patient who needs it as a result of the change in the method of payment.
I think there is.
To focus on the core issue of the question in relation to GPs in city centre areas, would the Minister accept that in the north side of this city there is inadequate GP cover? That is one of the strongest reasons for supporting the Temple Street Children's Hospital outpatients' department. Would he not accept that there are considerable problems in the north side of the city in having GPs on call? What proposals has the Minister to deal with those problems which now exist?
I accept that for a number of years there have been such problems. This appears to be a city problem. It does not exist to any large extent outside the city. There is insufficient cover — in some areas of the city, I might add. There are many areas of the city where general practitioners, either on their own or in groups, are providing an excellent level of service 24 hours a day. There are areas where this is not happening and we have taken up the matter with the Eastern Health Board because, principally, it is in Dublin that the problem arises.
What particular conclusions have the Eastern Health Board come to in relation to the problem? What proposals does the Minister envisage will be put forward to rectify the problem that he has acknowledged now exists?
It is not just now that I have acknowledged the problem; it has been there for years.
But he is the Minister now.
I have addressed the problem with the Eastern Health Board. We are looking to see how it can be resolved. There are a number of proposals and I will bring them to the Deputy's attention in due course.
Are there now two contracts in operation for the general medical service?
There are two questions on that specific issue and I do not know if I should answer this question now, or wait until we reach those questions.
In any event, the reply will be issued if not reached.