Gay Mitchell
Question:23 Mr. G. Mitchell asked the Minister for Health and Children the way in which he will tackle the crisis now facing general practice. [5522/01]
Ceisteanna–Questions (Resumed). - General Practice Crisis.
There is no crisis facing general practice. There is a need to address a number of serious infrastructural issues in general practice, including, its fragmented organisation, coupled with the growing volume and complexity of general practice work load, in order that its future development can be charted in a manner that maximises the contribution it can make to the overall health services.
This is all on the basis of a fundamental recognition that the health care system of the future will be characterised by greater integration and the maximisation of the contribution of component parts through better linkages, rising public expectations, increasing demands for additional health care services, especially of a screening or preventative type, and an increased focus on value for money from public expenditure. In that scenario, a more comprehensive and rationally developed general practice and primary care system should and can play a central role. To do so, it must be properly organised and resourced. It was in recognition of this that health board chief executive officers, with significant input from my Department, initiated a wide-ranging review of general practice.
The purpose of the review was to identify the measures necessary to meet the challenges posed if general practice were to be properly developed. That review has been completed and its findings are intended to serve as the basis for the future strategic development of general practice. I intend to obtain the agreement of Government to begin the process of moving forward in this area in a structured, logical manner and through a partnership process. An important aspect will be a wide-ranging consultative exercise with the representative bodies, especially the Irish Medical Organisation and the Irish College of General Practitioners which have produced a vision statement for the future. That jointly prepared document will feature as part of the consultative process referred to.
I look forward to a positive engagement with all concerned. Independently of the review, I am already addressing a number of issues of concern to general practitioners, their patients and the public, such as the provision of an appropriate out of hours general practitioner service. Pilot models are in place in two health board areas and funding will be made available this year to help all health boards develop out of hours GP services. After an evaluation, that process will continue. GPs will benefit in terms of workload commitments from these initiatives and I hope the positive support demonstrated by them for the out of hours projects will be manifest again in the broader strategic developments of the future.
The Minister might well be known as the Minister for Heinz rather than for Health and Children because he has 57 varieties of inquiries, consultative processes, fora, commissions and committees. How can he say general practice does not face a crisis when the IMO has threatened to withdraw from child vaccination schemes and from serving new medical card patients from 15 March next? Is the Minister aware that the IMO was so upset by the letter sent to it by the Health Service Employment Agency which was dismissive of GPs' needs that it has given rise to the possibility of the collapse of the medical card scheme? When the poorest people go without a medical card, they go without treatment. Given that these measures are threatened and that new medical card holders will not be accepted from 15 March on unless some movement is made, how can the Minister not accept there is a crisis in general practice? There is a serious crisis which he should have anticipated and dealt with given the resources the House has provided for him. What is his explanation?
Industrial relations issues do not constitute a crisis in general practice. Some of threats were unwarranted and should not have been made. Industrial relations are a two way process. I am available for discussions. I had arranged a meeting with the IMO which, for logistical reasons, it could not attend. It has met the HSEA. While I have endeavoured to meet the IMO, we had negotiations last year and the IMO president thanked me then for the constructive approach I adopted in the resolution of the issue of fees for the immunisation campaign. Through an independent arbitrator, we substantially increased the immunisation fees for a number of programmes from £89 to £128 per injection.
Those were issues from last year. Newer issues must be dealt with this year. The position concerning those over 70 is grossly overstated. Approximately 1.2 million people are in the general medical service. It was already agreed under the programme for Government that the eligibility threshold for all those over 70 would be doubled and the final phase of that was to apply in March, which would have added about 5% or an additional 25,000 people over 70. Some extreme comments have been made about those additional 25,000, a number which amounts to 14 additional patients on average per general practitioner or 2% of the overall number on the medical card scheme. That, along with other issues, is not a basis to threaten to withdraw from the overall immunisation programme.
Does the Minister agree the level of uptake in vaccinations for children is less than 80% and that 90% of GP practices do not have any equipment to deal with a vaccination which goes wrong, for example? Is it not time for the State to take the pressure off secondary care by giving GPs the incentive to invest in the development of their surgeries and practices so that primary care becomes a place of first call?
We have invested heavily in GP practices. We pay a substantial allowance for secretaries in practices. The issue of equipment is still under discussion although much of the basic equipment should be in GP practices in any event. Nonetheless, I am still willing to discuss that issue with them. We continue to invest in the out of hours practice and so forth. There has been ongoing investment. We accept the need for greater strategic development of the service and we are prepared to do that.