Dáil Éireann debate -
Tuesday, 16 Nov 1993

Vol. 435 No. 9

Written Answers. - General Practice in Rural Areas.

Alan M. Dukes

Question:

91 Mr. Dukes asked the Minister for Health if his attention has been drawn to a recent survey expressing serious concern at the future viability of General Practice in rural areas in view of the drop in population; the steps, if any, he proposes to take to ensure an adequate level of service.

Minister for Health (Mr. Howlin)

Demographic changes in population have implications for the organisation of general practice and the distribution of medical manpower. In determining general practitioner manpower needs in the General Medical Services (GMS) at regional level, health boards are required to ensure that patients have a proper level of access to general practitioner services and have a reasonable degree of choice having regard to the viability of practices. Where necessary, boards may contract with additional practitioners to provide services in particular areas.

In that regard the number of doctors providing services under the GMS has been increasing in recent years; currently there are 1,638 doctors participating in the scheme which is the highest number since the scheme was introduced. This figure is expected to increase further in the immediate future.

In rural areas and where population numbers are declining, special considerations are also necessary to ensure that practices remain viable and that doctors continue to be attracted to practice in rural areas. The GMS agreement provides a number of additional incentives for doctors who practice in rural areas where patient panels are geographically dispersed. Under the agreement capitation fees and payments in respect of domiciliary consultations are linked to the distance of patients from a doctor's surgery with higher rates paid for patients who live some distance from the surgery. In addition a rural practice allowance is payable to doctors who live and practice in areas which meet specific criteria in terms of population size and distribution.

The current GMS contract also provides for special considerations where doctors practice in remote areas. Following consultation with the relevant health boards and the Irish Medical Organisation a number of areas have been designated as remote areas which attract special considerations in respect of the remuneration package for doctors in such areas. This system is being closely monitored in the interests of continuing the provision of effective general practitioner services.

My Department's Blueprint for the Development of General Practice to which all parties to the current agreement are fully committed is specific in the need to continue to improve and develop general practice. The implementation of the blueprint is being pursued by my Department in conjunction with health board's general practice units. The on-going development of general practice in rural areas is an important part of this process.