Vol. 572 No. 2
3 Dr. Twomey asked the Minister for Health and Children the number of GMS lists in each health board that do not have a full-time contracted general practitioner; the length of time the post is run by a locum doctor; the number of GMS general practitioner lists that are under the direct supervision or management of the health boards; and if their attention has been drawn to the manpower problems in general practise. [22646/03]
There are currently 27 GMS lists in nine health board areas which do not have a full-time contracted general practitioner. There are 11 GMS lists under the direct supervision or management of the health boards. The length of time varies, in the main, from between two to 24 months.
There are a variety of reasons why GMS lists either do not have a contracted GP or are under health board control. Of these, seven relate to the resignation of the GP, four to approved leave of absence, three to extended sick leave and two to retirement. One is due to the reorganisation of a panel and one is a vacant post. A further three panels are occupied by "assistants with a view" to becoming partners in the practices, and taking over the lists. There are approximately seven further panels, covered by a locum, where clarification is still being sought by my Department.
As the Deputy will have noted, vacancies in the GP panels arise for valid and understandable reasons, such as sick leave or approved leave of absence. The Department and the health boards are acutely aware of needs in the area of general practice and meet routinely with the Irish College of General Practitioners to discuss the development of general professional and general practice training. The Department is committed to ensuring adequate cover for GP panels and also supports other important initiatives to enhance GP working conditions. It will also encourage the development of training programmes towards the achievement of both the highest standards of GP training and the provision of the increasing number of general practitioners required for primary care services in the future, as resources permit. The number of GPs with full-time GMS contracts has increased from 1,679 in 1999 to 2,134 in 2002.
There was a large increase in GP numbers shortly after the introduction of the over 70s deal. Some of us felt this deal discriminates against means tested medical card patients. However, that is an argument for another day. Manpower in general practice is based on supply of general practitioners and the demand on the service from patients. On the supply side the vocational training schemes are not producing enough general practitioners and many of those who are coming through do not want to work outside the affluent areas. Nobody, even those established in general practice, wants to work on call, especially on the very onerous rotas that exist in isolated rural areas.
The Deputy should ask a question.
None of these factors has been addressed. Only 1% of graduates from universities have expressed a willingness to work in single-handed practices. However, half of the doctors who will retire in the next ten years work in single-handed practices. On the demand side, the population in my constituency has increased by 10%. Thank God, the expectations of younger and older patients have increased. Younger people are presenting for tests such as cholesterol, diabetes and blood pressure, and we have an increasing elderly population for which we are making no allowance.
In fairness to other Deputies who have submitted questions, I must insist that you ask a question of the Minister. The purpose of Question Time is to elicit information from the Minister and not to impart information to the Minister.
All these should have been addressed in the Minister's answer to my question as to whether there was a problem with GP manpower.
I suggest the Deputy should ask his question by way of supplementary.
I ask the same question without the need for a supplementary. What will we do about the impending crisis in general practice when the population of GPs is ageing and young people are not coming into it in the numbers required? We seem to have our heads in the sand about this as appears to be confirmed by the Hanly report, which will suggest moving more workload into primary care. There is no capacity in primary care to take that on. As the Minister knows, the primary care strategy is moving so slowly that it is almost deemed irrelevant. These are the issues about GP manpower and service that need to be answered. Some doctors are no longer in their practices and we are finding it difficult to replace them.
The Deputy is raising some valid concerns about the future of general practice. Hanly has looked at certain elements of medical manpower as part of its remit. In conjunction with the Minister for Education and Science, I have recently established a group involving the deans of medicine in the universities, the Higher Education Authority and the Departments of Health and Children and Education and Science with a view to having a complete re-examination of undergraduate medical education and to establish recommendations.
I accept there are difficulties in certain areas. For socio-economic reasons we have a greater preponderance of GPs in certain areas as opposed to others. We need to look at that in a more focused way. The GP co-operative initiat ive, which was designed to improve the quality of life for GPs, was effective in giving viable career options of quality in rural and urban areas. We have developed those very quickly and we do not get enough credit for the rapid development of GP co-operatives around the country. Every health board area now has a GP co-operative and cumulatively we have spent about €46 million in a relatively short time towards the provision of GP co-operatives, which has a direct relationship with attracting and retaining people in general practice. Dublin is one area where the GP co-operatives have not taken off with the same effectiveness as they have around the country and one does not detect the same degree of enthusiasm in certain parts of Dublin for the general practice co-operatives as elsewhere.
Briefly—
Very briefly, please.
I completely accept that the co-operatives have been a great ray of light through the general practitioners service because of the necessity of keeping GPs in the areas where these have been established. Given the age profile of GPs there will be a large number retiring in five or ten years' time. Does the Department have a contingency plan to look after primary care services if this should happen to accelerate and large numbers leave the service?
We are addressing the manpower issue in terms of those who are coming forward in medicine. Medical undergraduate courses are being reviewed by a top level group. This will be a root and branch review of what is happening in undergraduate medicine and where we go from there.
Another report.
It has to happen and it should have happened years ago.
