Dáil Éireann Debate, Thursday - 20 April 2023
1. Deputy David Cullinane asked the Minister for Health when he will publish a plan for achieving universal GP care; when he will publish the details of the free GP expansion promised in the budget for 2023; and if he will make a statement on the matter. [17404/23]
View answerMy first question is in respect of the roll-out of free GP care. As the Minister will be aware, we discussed this at yesterday's meeting of the Joint Committee on Health. Will he give the House an update as to when the additional cards that were promised in budget 2023 will be delivered and the engagements he is having with the Irish Medical Organisation, IMO, to progress this matter?
I thank the Deputy for the question. As we are all aware, universal healthcare is something we are all signed up to through Sláintecare and are committed to very strongly in the programme for Government, and this is a core element of that. One of the three tests of universal healthcare is that care is either free or affordable for everybody who needs to use it. As the Deputy and colleagues will be aware, it is my intention to expand eligibility by approximately 500,000 GP cards, which is a substantial increase. The original plan had been to roll it out at the start of this month. The IMO and GPs around the country got in touch and asked that we wait and continue with our engagement with them and it is something I have agreed to do. I hope that we can do this by agreement but, regardless, I want to respect our GP community and the IMO and give the talks that bit of extra time - not a great deal of extra time, but some extra time - for some quite intensive discussions.
As the Deputy will be aware, approximately 2.1 million men, women and children have either a medical card or GP card. Essentially, as I said to the GPs this past weekend at the IMO conference, we have three groups of people accessing GP care. We have those with medical cards and GP cards for whom the State fund their access. We have people who pay the private fees of GPs and can afford to do so. We then have a third group of people who do not qualify for GP cards and who very much cannot afford the fee, be it €50, €60 or €70, to visit their GP. We know that there are people who need to see a GP, or whose child needs to see a GP, and they are putting off that visit. That is something that no GP that I have spoken to wants either. Essentially, we are doing a short round of intensive engagements with the IMO. I have put a very substantial amount on the table in respect of permanent recurrent funding to support general practice so that we can expand capacity in general practice at the same time as we increase demand through State-funded access.
The date of 1 April was not one I set but one that was set very clearly by the Minister in the budget for this year. Ministers make big announcements like this. It was a big announcement and it is significant that we are looking to expand free GP care to hundreds of thousands more citizens. It is something that I included in Sinn Féin’s alternative budget and is very similar to the Minister’s proposals. I also made the point in our alternative budget for this year that we need to put in place the building blocks and additional capacity and supports for GPs, who are also stretched, and we have to ensure that we can do this. Setting a date, however, and missing a target is not something that should be done because people need to have confidence when a Minister stands up on budget day and says he or she is going to do something on 1 April, that he or she has the ducks lined up, that it is going to be done and that this is an announcement that will be delivered upon. This has not been the case and yesterday I was still not given any timeframe as to when this will happen. I will, therefore, ask the Minister this question again today. Is it next month, May, June, July or when are we likely to see these 500,000 people getting the free GP card?
I thank the Deputy for his reply and I do not disagree with his analysis at all. It is frustrating to me that we did not bring it in this month. The Deputy is absolutely correct in that this was the plan and that was what we budgeted for and what we wanted to achieve. The GP community asked us to wait and the choice was to proceed, which we could have done in spite of that, or to give the process a bit more time out of respect for general practice to ensure that we get it right. I would have much preferred to have made the April deadline. We are going to give this a short extended period, very much out of respect for general practice and for the fantastic work it does and out of respect for the union to give it that extra bit of time.
A substantial amount is available and in discussions over the weekend with GPs I pointed out that there is money for a significant increase in practice nurses, investment in information technology, which is something that many GP practices want, and to examine fees for the general medical services, GMS, scheme and other measures we will use to try to make this work and get it right.
What we need more than ever now is a roadmap to full universal cover and an agreed timeframe with the representative bodies because for too long, we were trying to do this by age and have lengthy contracts with them, which actually did not work. The delivery of the free GP cards for six- and seven-year-olds was promised years ago and did not happen because of contractual disagreements and so on. An agreed plan between Government and the representative bodies is needed. How will those 500,000 cards be delivered? When will that be done? Beyond that, when will they delivered to the rest of the population? The eligibility for those 500,000 people below the median income needs to be expanded in respect of full cover under the medical card. We need an agreed timeframe and an agreed plan and I hope that that is something that, in time, will emerge from the Minister’s discussions with the IMO.
Yes, it will. The Deputy will be aware that we are kicking off a strategic review of GP practice. It is based on a report that was published not long ago on the future of general practice. We accept that report. A team is being put in place now and I have appointed three GPs to the team to ensure that the voice of the doctor is very much front and centre on that.
Essentially, the process is that we have 500,000 cards to bring in this year. That comprises approximately 70,000 cards to cover six- and seven-year-olds and approximately 430,000 cards to take eligibility up to the median income. At that point we will have added significant eligibility, so we will probably need to pause for a bit.
The conversations we are having with the IMO relate to bringing in the 500,000 cards this year and the strategic review with the IMO, GPs and the experts. Coming out of that there will be recommendations for a new GP contract so there will be a negotiation of the GMS scheme. As part of that discussion I want to see exactly what the Deputy outlined. We want to move. It was called for in Sláintecare. It is backed by everybody, I think, in the House. We will then find a pathway critically and sustainably, while we add capacity to the system, for universal access so that every man, woman and child in this country ultimately will have State-funded access to general practice.
