Vol. 431 No. 8
6 Mr. J. O'Keeffe asked the Minister for Health if it is Government policy to reduce the number of doctors in the GMS and accordingly not to replace some of those retiring or leaving the service; and if the doctor retiring in Drimoleague, County Cork, will be replaced.
It has been the long standing policy of successive Governments that there should be a sufficient number of doctors to allow a reasonable choice for GMS patients and, at the same time, have regard to the questions of viability of practices.
The annual trend in recent years of an increase in the number of doctors in the general medical services will continue this year. It is expected that there will be a significant increase in the number of doctors with GMS contracts at the end of this year compared with the position at the end of 1992. As a result there will be the highest number of doctors providing services to medical card patients since the scheme began.
The appointment of doctors to the GMS and the filling of vacancies which may arise in a particular area are matters for the chief executive officer of the relevant health board in accordance with the procedures agreed with the Irish Medical Organisation. As regards the specific case referred to by the Deputy, the chief executive officer of the Southern Health Board is currently examining the general practice situation in Drimoleague with particular regard to the requirements of GMS patients and is expected to make a decision shortly in regard to the filling of the vacancy.
Will the Minister accept that there is an uncertainty in regard to the optimum numbers involved in a particular practice? What are his views on the size of the average general practitioner's practise?
May I say that the average size of panel has actually dropped in recent years, from 875 on average in 1986 to the expected number of 719 this year. The outturn for last year was 778. The number of doctors participating in the GMS within the same period has increased from 1,512 to an expected 1,770 by the end of this year. It is very hard for me to have a clear view of what is the optimum practice; it is something we monitor, comprised of a correlation of a number of factors, such as the efficiency with which patients, who are contracted on a panel, are seen and cared for and the provision of a comprehensive service and locum cover in a practice itself.
May I put it to the Minister that, in many parts of the country, we are seeing an amalgamation of lists to a degree not seen heretofore? Would he agree that, unless a policy emanates from his Department on the matter, the result will be similar to that experienced already in many parts of the country, where post offices, Garda stations and schools go, with the general practitioner service now, on line for amalgamation and location in a larger town, thus denying many members of rural communities of a service.
There are a number of manpower issues under the GMS that are being addressed, some bilaterally between management and the Irish Medical Organisation, in relation to the provision of services. On the broader front, the GMS management side are considering how best to address future management issues in relation to practice, with particular reference to the general medical services. One option which has been included in the Department's position is the establishment of a national council for general practice. There are ongoing reviews in relation to the structure of general practice until the end of this decade and into the next century. The establishment of general practice units within the health boards is a very important additional resource which will encourage and help the development of general practice. By way of policy, I am strongly of the view that general practice has to be strengthened and the whole, primary delivery of medical services should be a new focus in the health services nationally.
In relation to the overall review of the general medical services and doctors' location, does the Minister intend to ensure that patients are located within a reasonable distance of their local doctor? The tendency in the past has been to see the amalgamation of practices with a greater distance growing between a patient in a rural area and their nearest GMS doctor. With all the attention now being paid to the survival of rural communities, the Department of Health will have to examine servicing patients in rural communities so that they do not have to travel 50 to 60 miles to their nearest doctor.
Is the Minister considering job-sharing in the GMS to ensure that the maximum number of doctors can work within the provisions of the scheme while, at the same time, ensuring that job-sharing provides a good return in relation to skills and services on a geographic basis?
I would be mindful of the first point the Deputy makes in relation to geographic areas. It was implicit in what I said in relation to the criterion, that it would be most important that patients on a panel would have ready access to a doctor, particularly in times of emergency. It is primarily the responsibility of the chief executive officer of the relevant health boards, in current legislative terms, but it is certainly one on which the Department would have an overview if there were a trend towards amalgamation which would impact adversely on the smaller community.
I should say I am well disposed to the notion of job-sharing throughout the health services. There have been difficulties experienced in the past in a number of areas, particularly in the nursing area. Difficulties were put forward for which I could not find a justification. I am hoping that those issues can be resolved so that the maximum number of people can be employed in the health service which it can pay for and, at the same time, while providing the greatest flexibility for staff to enable them change their lifestyles. I have not a closed mind in relation to job-sharing.
Is it correct that the matrons in hospitals objected to the concept of job-sharing among nurses? Has he taken any steps to adopt a leadership role in persuading matrons to review their views on this very good proposal?
I think the Deputy is extending the question of the GMS into a new area. I am mindful of the difficulties put in the way of some nurses job-sharing and I am anxious and eager to resolve those difficulties.
