Seanad Éireann debate -
Thursday, 12 Apr 2001

Vol. 166 No. 6

Adjournment Matters. - General Practitioner Services.

Ms O'Meara

Thank you for allowing me to raise this matter today. I also thank the Minister of State for coming here to reply.

I raise the issue of the need for funding to initiate a GP co-operative in north Tipperary because it has been raised with me directly by a number of general practitioners in the area. They have informed me that an application for funding was made through the Mid-Western Health Board to the Government. Funding of between £400,000 and £500,000 was requested to establish a GP co-operative in north Tipperary. Even before that application had been made, a considerable amount of work had been done by the GPs in the area, to such an extent that there is now wide agreement on the need for a GP co-operative. The proposal which went to the Department was comprehensive, and had funding become available, it would have been possible to establish the co-operative immediately. It is a pity the Department did not find it possible to fund the co-operative. I put it to the Minister on behalf of GPs and their patients, particularly public patients, that it is necessary for the Department to re-examine this issue.

Because of his background, the Minister will be aware that the role and lifestyle of the GP is undergoing great change, particularly in rural areas. The number of women involved in general practice has increased to a huge extent and that is a good thing because gender balance is desirable in all professions. My information is that the number of medical students opting for the GP programme is now hugely imbalanced in favour of women and that the number of leaving certificate students applying to study medicine is again vastly over-represented on the female side. This means that we are rapidly moving into a situation where the majority, between 80% and 90%, of qualified GPs are women. This has changed the whole structure of the GP service.

I have been told it is very difficult to get GPs to join rural practices and virtually impossible if they are women. Women cannot take on the onerous responsibility of being on call and going out at night on a regular basis. It is not possible to provide that kind of service at the same time as being a wife and mother. Their desire to have a reasonable quality of life results in their choosing not to take on a rural practice.

As the Minister knows the idea of a co-operative is an excellent one, and I do not need to go through the details. Cover is available, as is physical security by the provision of a driver. The quality of the GP's family life is thereby improved. Where the co-operative system is in operation it provides value for money, which is important from the viewpoint of the Department of Health and Children.

The provision of a nurse at a central location who can be contacted by phone on a 24 hour basis has reduced the necessity of follow up GP visits from calls made to the co-operative service by up to 40%. This is a very good use of resources.

It is my understanding that other areas of the country were provided with funding this year to establish a service. Even though the north Tipperary model is ready, funding was not provided and it is urgently required. My plea is part of a campaign being undertaken by the GPs of north Tipperary in relation to this.

Will the Minister look at how other parts of the country are spending their allocations? If the full amount is not being spent then I would urge the Minister to divert that money to the north Tipperary scheme, which as I said is ready to go. I look forward to a positive response from the Minister on this urgent issue. It needs attention and in the immediate short term it needs funding.

Minister of State at the Department of Health and Children (Dr. Moffatt)

One of the key objectives of the Minister for Health and Children is to promote, develop and provide a modern integrated primary care service that is responsive to the needs of patients in a manner that is efficient, effective and equitable. The development of primary care services must, of course, also be consistent with the overall strategic and integrated development of the health services generally. In that regard, further to the review of general medical practice recently carried out by the health board chief executive officers, the Minister is planning to commence a wide-ranging consultative process with all the relevant stakeholders with a view to formulating a blueprint for the future long-term development of general practice.

The provision of an appropriate general practitioner out of hours service is an essential aspect of moving forward in this area. The increasing public perception of difficulties in accessing GP services at nights, weekends and public holidays has placed growing and inappropriate pressures on hospitals, especially accident and emergency departments. Accompanying this trend has been a very substantial increase in costs for those out of hours GP services that are being provided. Accordingly, the Minister is determined to ensure that the policy response in this area is a national one that ensures a quality based patient service in a value for money framework. The matter of developing GP co-ops or other out of hours structures in the Mid-Western Health Board or anywhere else must be consistent with that strategy.

The Minister sees the development of the out of hours GP co-operative model as being one way to progress service delivery, meet patients' needs and provide satisfactory working schedules for participating GPs. Such co-ops are backed by strong support structures provided by health boards that facilitate a proper and quick response to calls made. They also offer the opportunity for participating doctors to better organise their out of hours schedules and hence have more time for family and other important social commitments.

Currently, there are two major GP out of hours co-op models being piloted in the North Eastern Health Board and South Eastern Health Board areas, North East DOC and CAREDOC respectively. They are undergoing a rigorous and independent evaluation. Following that evaluation, the first stage of which I expect to be completed by late May, the Minister will be in a position to make an objectively informed decision on how best to progress out of hours developments throughout the rest of the country.

My Department is also organising a national conference, involving all the stakeholders, to discuss all the issues relating to developing appropriate models. That conference was originally scheduled for late March but has been rescheduled due to foot and mouth considerations until May. The Minister hopes that the conference will allow all the parties to identify and consider the range of options that are available to address the out of hours situation and he looks forward to constructive ideas and proposals emerging from it.

In that regard, it is important to emphasise that the co-op model is only one possible model for providing the required degree of out of hours GP service. In the light of the evaluation and the national conference other more suitable models might come to the fore, either for particular communities, regions or even nationally. For example, in the Dublin area, DUBDOC is an out of hours service provided by GPs from the grounds of St. James's Hospital. As Minister, the important thing is that there is a commitment to address the needs of this area through appropriate means that offer a quality based patient service and meet the needs of participating GPs in a value for money framework.

The bulk of out of hours funding provided this year was allocated to finance the ongoing costs of the existing pilots in NEHB and SEHB areas. A significant amount was also provided to the Southern Health Board to allow for the next major structured out of hours initiative to commence in that region. That will not happen until the evaluation exercise currently underway for CAREDOC and North East DOC is completed.

As a means of ensuring tangible progress in this area in every health board region, the Minister has also provided funding to each board in 2001 to facilitate work on progressing the infrastructural issues surrounding the development of out of hours GP models in their regions.

Specifically, the Mid-Western Health Board received £140,000. It has used some of that money to employ a full-time project manager to oversee the development of an out of hours project in that region and he is currently working with a geographically representative steering group of ten GPs in the region. In line with national policy, that group decided that an incremental approach to developing a working model was the best way to proceed and they have identified five geographic cells, the idea being that the cells would be developed sequentially on the basis of experience, evaluation and funding. The steering group has chosen County Clare as the first cell in the Mid-Western Health Board region. That is their choice. They will also, in the first instance, make the choice on which geographic area will be next. All cell developments will, of course, also be subject to proper evaluation and accountability.

Having regard to all of the above, the Minister is satisfied that the approach being pursued is the proper one. Accordingly, decisions on future funding and progress will be made in the light of the processes outlined above.

The Seanad adjourned at 1.30 p.m. sine die.