Vol. 413 No. 7
14 Mr. Byrne asked the Minister for Health if she has any plans to provide incentives for general practitioners to form group practices which would be in a position to offer services for longer hours than doctors in practice on their own, particularly with a view to relieving pressure on accident and emergency services in hospitals; and if she will make a statement on the matter.
22 Mr. R. Bruton asked the Minister for Health if she has satisfied herself with the system for promoting a wider range of care services in the surgeries of general practitioners; and if she will make a statement on the matter.
I propose to take Questions Nos. 14 and 22 together. The new contract between health boards and general practitioners for the provision of services to medical card holders which was introduced in 1989 changed the method of payment from a fee per visit to a capitation based system. One of the principles behind the revised method of payment was to allow the doctor sufficient time to deal with individual patient problems in a comprehensive manner, thereby maximising the ability of general practice to meet the health needs of medical card patients.
The new contract extended the range of special services in respect of which general practitioners are paid an additional fee and which otherwise would have to be provided in a hospital setting. Annual subsidies are paid in respect of the employment of practice nurses, which enable general practitioners to provide a broader range of care services.
General practitioners are also entitled to fees for visits outside normal working hours. Arrangements are being put in place to allow for the payment of fees for special services and out of hours visits which are provided by a doctor within a group/partnership or rota arrangement in respect of a patient of another doctor within the particular arrangement. It is hoped that this will further encourage the development of group/partnerships and rota arrangements.
I am very much aware of the important role of general practitioners in the provision of a comprehensive and cost-effective health service. The measures which I have outlined were introduced to encourage a more comprehensive service at primary care level and the question of whether further initiatives are required in this area will be considered as part of the forthcoming review of the general medical services scheme, which is due to commence in March 1992.
My question was not specific to medical card holders. It was a more general question about the clogging up of the accident and emergency services and the provision of an alternative. Is the Minister aware of the Hynes report which showed that 20.5 per cent of those in attendance at accident and emergency units were considered to be inappropriate to the accident and emergency services? Would the Minister agree that one way to attract those people back to the part of the system in which they should be involved — the service provided by general practitioners — would be to encourage larger practices to open for longer hours and more flexible times so that if someone required one or two stitches then he or she would not have to join the queue at an accident and emergency unit but could go to a general practitioner? That is the message that I was trying to get across — an alternative system to ease the huge waiting lists and prevent the clogging up at accident and emergency units.
The Deputy is making a very sensible point. The GMS contract provided for the payment of additional fees to general practitioners in relation to several other forms of service, which are all included in the list. A review of the position will commence quite early in 1992. I agree that what the Deputy has said is common sense.
Would the Minister not accept that the 1989 agreement provided for development grants for doctors surgeries so that doctors could do the kind of work that would keep people out of accident and emergency units and that her Department failed to honour the commitment given in that contract? Would she not further agree that there is enormous scope for general practitioners to handle cases that now end up in the hospitals, among them the cases of stable disabetics, angina cases and blood pressure-related complications? Could the Minister make this an area that she will examine as a matter of urgency?
I do not accept at all that the Department of Health failed to honour their agreement.
You will find that later this afternoon.
I note that in 1990 alone general practitioners were paid £1.1 million for special items of service. That was in line——
It was to equip.
——with the 1989 agreement. I accept that these matters can be looked at more keenly in the coming overall review.
Will the Minister release the report on accident and emergency services which shows that the Minister's attempted saving of £750,000 by closing two acute hospital accident and emergency services in the evening is not working and is contributing enormously to the delay for elective treatment for thousands of patients?
I shall certainly read the report first.
I am assured by the health board that it is on the Minister's desk.
The Deputy should see my desk. I shall certainly read the report.
Would the Minister reconsider her reply that the grants for development of practices were paid? My information is that no such grants were paid.
I must at this point in my career go by what is put to me. My advice is that in 1990 general practitioners were paid £1.1 million for special items of service.
They are services, not equipment. The grants were for development.
What I read out to the Deputy is what is in my brief.
But I asked the Minister about equipment.
General practitioners were paid £1.1 million. The Deputy is trying to say that I said something else but I did not. I said that general practitioners——
The Minister was asked one thing but she is answering something else.
General practitioners were paid £1.1 million for special items of service in 1990.
