I propose to take Questions Nos. 1035, 1095, 1096 and 1099 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 six 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.
I am satisfied that there is ample evidence to suggest that access to primary care services helps to improve health outcomes, to prevent the development of chronic conditions and to effect savings in the acute hospital sector.
The Report of the Expert Advisory Group on the Early Years Strategy recommended that all children under the age of six years should be given access to free GP care. The Trinity College Centre for Health Policy and Management and the Adelaide Hospital Society report entitled Social Health Insurance: Further Options for Ireland, noted that internationally there are strong grounds for providing free health care for children, particularly given their burden of ill health.
A draft contract for the provision of free GP care to children under six 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. Furthermore, I wrote to the Irish Medical Organisation (IMO) on 27th February 2014, 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.
Under the existing contract, GPs contracted under the General Medical Services Scheme must make suitable arrangements to enable contact to be made with them (or a locum/deputy) for emergencies outside normal practice hours. Co-operatives provide an ideal facility to enable GPs to discharge this obligation. The draft under six contract also makes provision for GP out-of-hours services, the details of which I expect will be the subject of further discussions with the GPs. I would wish to state again that no decision has been taken on the rates of fees payable to GPs for services included in the draft under six contract, including out-of-hours payments. These will be addressed through the fee setting process outlined above.
The Deputies' questions raise a number of other specific issues, including disease surveillance and health promotion. 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. I expect that issues such as these and the regularity of performance reviews will be the subject of further discussions with the GPs.
