I very much welcome the opportunity to raise this important matter and am glad that the Minister has remained to listen. I am disappointed that the Minister for Health, or somebody representing him, is not present as this is a matter which involves him.
Adjournment Matters. - County Cork GP Service.
An Leas-Chathaoirleach
He is out of the country.
Killavullen in North Cork has a population of 1,300 people. It is a separate entity, a parish on its own and always, since the foundation of the State, had the service of a general practitioner resident in the area. Before that there was always a doctor there. In 1981 Dr. O'Donoghue was appointed to fill the vacant position there. At that time there were 501 patients on the panel and each year that panel reduced. The health board executive and officials were well aware of that and why the panel was reducing so rapidly. There is no doubt that there was poaching by other GPs. There is proof of that, and the executive of the board tacitly agreed with what was happening by doing nothing about it.
In May 1995 the community care committee of the board were advised by the programme manager that it was proposed to discontinue the practice at Killavullen and that the vacancy would not be filled when the general practitioner retired in July 1995. The community care committee of the board, which consists of members from the city and county of Cork, rejected that. They said they would not accept it and gave their reasons. The matter went back to the July meeting of the Southern Health Board which decided to refer the matter back to the community care committee for further consideration. At that meeting of the community care committee, with one exception who was the IMO representative, the members again recommended that the vacancy be filled and that the person in question reside in Killavullen. At its September meeting the Southern Health Board decided by 28 votes to one to adopt the resolution and instructed the chief executive officer to make the appointment under section 58. However, the chief executive officer invoked the health services regulations of 1972 — that any function of a health board as respects the arrangements under the statute shall be a function of the chief executive officer. Talk about democracy.
The health board executive issued a document in which it stated:
The allegation is that the Southern Health Board "allowed a situation to develop and continue whereby GMS patients were forced out of Killavullen". We refute this absolutely. The retired GP was not an employee of the board. [What was he? He had a contract with the board to provide a service.] A level of support, which cannot be published, was provided which was not alone addressed to the individual's difficulties but also attempted to protect the panel.
The health board executive said that the board helped the GP in order to protect the panel. How did it help him? It was an appalling situation. He is the finest person one could meet but there was a serious problem. On certain days, he scarcely knew one patient from another — can I say more? That was presided over by the executive of the board which is now invoking its power under the section to discontinue the practice. It is assigning a GP to Killavullen for one day a week or perhaps one hour a day for five days. However, Killavullen is a sprawling parish. There is a wheelchair bound person living alone in a remote area called Cloughlooha. The nearest GP is nine miles away and the patient does not have a choice of doctor.
The people of Killavullen have the support of the South of Ireland Locum, Trainee, Assistant and Private Doctors' Association in their campaign for the appointment of a resident local GP under the GMS service. That is a strong statement. The board is now providing Killavullen with the services of a young GP who came to the area as an assistant to a GP who is on maternity leave. A little further north, in the Doneraile area, the GP is on sick leave. The health board gave the members of the board details of the number of GPs which it said could cover the area. However, those numbers are unrealistic as Fermoy, Glantane and Doneraile are very far from Killavullen.
Circular 2/95, which I quoted, is the agreement between the Minister and the Irish Medical Organisation but its provisions are not being complied with. The circular states that consideration must be given to:
The provision of a proper level of access to general practitioner services for patients, that patients have a reasonable degree of choice in selecting a practitioner, and that due regard is given to the question of the viability of practices in the area in question.
We know why the practice may not be viable and that parts 1 and 2 of that agreement are not being complied with. Will the Minister give serious consideration to this matter and have a GP appointed to the people of Killavullen?
I thank the Senator for the opportunity to speak on this matter on behalf of my colleague the Minister for Health. I should first explain that the appointment of general practitioners to the general medical services scheme is a function of the chief executive officer of the relevant health board.
Under circular 2/95 which deals with the arrangements for the provision of general medical services under section 58 of the Health Act, 1970, regarding the filling of a vacancy or the creation of a new post in the GMS, health boards take the following considerations into account in arriving at a decision: first, the necessity to provide a proper level of access to general practitioner services for medical card patients; second, that patients have a reasonable degree of choice in selecting practitioners; and, third, that due regard is given to the question of the viability of practices in the area in question.
The Minister for Health understands from the Southern Health Board that the doctor in Killavullen has resigned from his GMS contract with effect from 31 July 1995. The board has indicated to the Minister that there were 126 GMS patients on this doctor's panel at the date of retirement. Figures published for the end of December 1994 show that the average GMS panel size for the Southern Health Board is 674 patients while the national average is 772 patients. The board is of the view that the viability of the Killavullen practice is such that it would be difficult to attract suitable candidates.
The board is concerned to ensure that the people entitled to GMS services have access to a quality general practitioner service. Having regard to the viability of the Killavullen post and the fact that there are 27 general practitioners providing services within a 10 mile radius of Killavullen, of which 19 provide cover for GMS patients, the Southern Health Board decided that the needs of the patients on this panel can best be served by their being offered a choice from the considerable number of other doctors serving the area.
Accordingly, the board wrote to each of the 126 patients concerned offering them a choice of doctor in the area. So far, 100 of these patients have indicated their choice to the board and the remaining 26 patients are without cover because they do not want to move to a general practitioner outside the village. The board has now arranged for general practitioner medical services to be provided in Killavullen with an attendance at the surgery in Killavullen on a five day week basis. Emergency cover will be provided through an arrangement between the GPs in the area.
I thank the Minister. Unfortunately, he has read out what the executive of the board read out at a board meeting. That is a sad state of affairs and I will take the matter further.
The Minister is doing his best.
I appreciate that. I thank the Chair for giving me the opportunity to raise this serious matter.
The Seanad adjourned at 2.30 p.m. sine die.