Vol. 457 No. 4
13 Dr. Moffatt asked the Minister for Health if it will be the practice of his Department and the health boards to let general practitioners buy specific services for their GMS patients from the private sector, with reimbursement of cost to the same general practitioners. [15676/95]
(Limerick East): As the Deputy will be aware, since 1993 a number of initiatives have been taken for the purposes of organising and supporting the general practitioner service in fulfilling a wider and a more integrated role in the healthcare system. The mechanisms for developing the service agreed with the Irish Medical Organisation and the Irish College of General Practitioners include the operation of an incentive based drug target scheme and the provision of a fund for the improvement of physical facilities and development of services within general practice.
The Department requested health boards to allocate a proportion of development resources towards the provision of a range of paramedical services to which general practitioners would have ready access for their patients. These would include physiotherapy, occupational therapy, chiropody, dietetic services and counselling. Health boards were informed that arrangements with service providers under this programme could be entered into on a contract for service basis either through sessional arrangements or short fixed term contracts. In this connection, it is open to boards to make arrangements, either directly or through general practitioners, with health professionals who are providing services in a private capacity. Any such arrangements are subject to agreement on funding and levels of service to be provided.
I should emphasise that the purpose of this initiative is to provide a more accessible service for medical card patients and it was taken following feedback received from practising general practitioners.
Has the Minister made all the various health boards aware of this because it only seems to be happening in the Eastern Health Board at present? Does he consider the way forward to lie in privatising many of the functions and facilities health boards provide for GMS patients, particularly those services he mentioned, such as physiotherapy? The Minister could add orthodontic services and facilities for the handicapped. I believe there is a number of FAS schemes in progress to facilitate people with handicaps. Does the Minister see this policy as the way forward in the health services? Should we be privatising more of our facilities?
(Limerick East): My approach would be non-ideological. I take a service from wherever I can find it if it provides a better service, especially for persons on medical cards. The origins of the scheme to which the Deputy refers is, as the Deputy would know, that arrangements were entered into with general practitioners on what is colloquially called the 50/50 cash back drugs scheme. By way of providing incentives, extra services were provided. One of those was to physically upgrade GP practices, dispensaries and so on. This has been done in various parts of the country. This arrangement was made too and it is working well. It was done with the full co-operation of medical practitioners and it has improved services for medical card holders in terms of advice on diet, physiotherapy, chiropody and so on. It involves the general practitioner getting into a contract of service or buying an item of service from a private service provider but, of course, it is subject to the health board being satisfied with the service which is being provided and the cost of it.
It is not correct to say this occurs only in the Eastern Health Board area. When I first read my briefing note I thought the arrangement was confined to the Western Health Board area because there are more instances of it in that area than elsewhere. For example, there are physiotherapy services available at Merlin Park Hospital, Galway to which GPs in the Galway area refer patients. A sum of £35,000 has been provided for sessions there and the service seems to be working well for the benefit of patients. A physiotherapy scheme was also introduced in Mayo-Roscommon, where GPs can refer patients directly to a private physiotherapist. The cost of that service will be recouped to the GPs by the health board, again, from the drug savings on the scheme to which I referred. Also in Galway, additional clinical sessions have been establisehd by the board at University College Hospital, Galway where dietetic services are provided.
New clinic sessions have been provided in a number of health centres around the country. As the Deputy says, the Eastern Health Board provides some services too. All general practitioners in the Eastern Health Board area were asked for proposals on the provision of physiotherapy, dietetic and psychiatric counselling services. It was suggested that they could provide the service in one of three ways — a group of general practitioners could recruit service providers on a contract basis; general practitioners could contract services for patients through established local service providers or make appropriate arrangements with local hospitals. I presume the letter which was sent from the Eastern Health Board to all general practitioners was taken as a new initiative whereas the practice is fairly widespread in the Western Health Board area and has worked well. I would like to see it applied generally.
Is it tied into drugs savings?
(Limerick East): I understand that is the position.
It is not a general service and, in the main, will not be of use in general practice. Patients awaiting treatment experience long delays. Many doctors do not have savings. What is the position there?
(Limerick East): That is a different question. I do not have that information to hand. I welcome the initiative where general practitioners purchase services from private service providers. It works well and I would like to see it extended. If the Deputy tables a question on the non-availability of physiotherapy services to GMS patients nationally, I will give him as much information as I can.
