Dáil Éireann debate -
Tuesday, 24 May 1994

Vol. 443 No. 1

Written Answers. - General Practice Organisation.

Frances Fitzgerald

Question:

130 Ms F. Fitzgerald asked the Minister for Health his views on the particular problems facing rural general practitioners and the implications for the workload and resources of general practitioners of the transfer of services from hospitals into the communities.

Minister for Health (Mr. Howlin)

The National Health Strategy, which I launched recently identified a number of organisational weaknesses affecting general practice in Ireland which are of particular relevance to general practice in rural areas. General practitioners, particularly rural practitioners, often work in isolation from their practising colleagues. Such isolation is also evident in the need to improve rural general practitioners' interface with other primary care services and hospital services. Because of the manner in which general practitioner services are organised, with the preponderence of single handed practices, there are inefficiencies in the use of resources, duplication of costs and increased workload for general practitioners.

The main purpose of the strategy in so far as general practice is concerned is to ensure that the service will be better organised and supported in fulfilling a wider and more integrated role in the health care system. In achieving this aim, incentives for the improved organisation of general practice will be designed so that patients have easier access to a wider range of services provided by their general practitioner. Assistance will be targeted on group practices, amalgamated practices and in particular on co-operative type arrangements which are in many instances more applicable in a rural setting.

Health board general practice units are currently developing proposals with individual general practitioners which will address organisational problems particularly those relating to rural practitioners. Units are also developing arrangements with practitioners to provide additional services where these can be carried out more cost-effectively than at present. This is particularly relevant in relation to the transfer of services from hospitals into the community referred to by the Deputy. Such services may include paramedical services, diagnostic services traditionally performed within hospitals, counselling and nursing services.

The strategy is specific in ensuring that treatment and care are provided in the most appropriate setting. In addition, there are opportunities for the improved interface between the general practitioners and the hospital service by the involvement of hospital outreach clinics within general practice, the development of combined care protocols and pre-hospital referral protocols involving general practitioners and consultants.

There are important opportunities for the development of general practice in rural areas on the lines I have outlined. The successful implementation of the strategy requires that general practice has the capacity through appropriate organisational arrangements and the resources to respond effectively to such developments. I am satisfied that resources will continue to be made available to implement these important elements of the National Health Strategy.