I propose to take Questions Nos. 189, 190, 215, 224, 225 and 230 together.
The Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government and the Future Health strategy framework. As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children under 6 years with access to a GP service without fees. The implementation of this measure will require primary legislation, which I expect to be published shortly.
A draft contract for the provision of free GP care to children under 6 years, is currently the subject of a consultation process. I would wish to emphasise that the document is a draft and I have no doubt that there will be changes to the text following the consultation process. I have offered to meet with the GP organisations in the coming weeks for more detailed discussions on the scope and content of the draft contract. This will afford them the fullest opportunity to raise any and all issues which they may have regarding the draft contract.
On 27 February 2014, I wrote to the IMO stating that the Department and the HSE are fully prepared to engage meaningfully with them and are prepared to negotiate with them on all aspects of the scope and content of the proposed contract. However, the ultimate setting of fees must remain a matter for the Minister for Health, though there will be an opportunity for their input on the fee structure, which it is proposed to address by means of a separate consultation process. The IMO has been formally invited to meet with the Department and the HSE to commence this process.
With reference to the question which infers that the draft contract is placing a “gagging order” on GPs, the specific clause in the draft contract relating to this (Clause 28.4.4) is intended to reflect and be protective of the HSE's interests given that the primary statutory obligations to provide general practitioner medical and surgical services will rest with the HSE. It is not in any sense intended to impose unwarranted or inappropriate restrictions on individual GP contractors in advocating on behalf of their patients.
A similar clause can be found in the form of agreement with Clinical Dental Technicians, which was introduced in 2011. The clause in question should be viewed in the context of the entire draft document, where the intent is to balance the duties, obligations and rights of both parties, while at the same time, having due regard to the overriding statutory obligations that will rest with the HSE.
The obligations set out in the draft contract relating to the inspection of records by the HSE are a standard feature of most contracts for the provision of health and social services on behalf of the HSE. Among the circumstances in which they might need to be invoked would be where patient safety concerns arise; where concerns exist about the quality of services being provided; in processing complaints from patients/relatives; and for probity assurance purposes. In exercising a provision of this nature, the HSE would be obliged to have due regard to patient confidentiality considerations, the need for patient consent and applicable legislative obligations.
With regard to the Deputy’s question about a change of policy in relation to a return to domiciliary visits, I emphasise that it is a matter for individual doctors to determine whether their patients require domiciliary visits. Doctors must always be guided by their primary responsibility to act in the best interests of their patients.
The Deputies' questions raise a number of other specific issues, such as periodic wellness assessments; health surveillance and protection activities; and the collation of information for epidemiological purposes. Such activities will ensure that the proposed scope of service under the contract is not limited to “diagnosis and treatment” but will include participation in active health promotion, disease surveillance, prevention and appropriate management of chronic conditions. However, I expect that issues such as these will be the subject of further discussions with the GPs.