Dáil Éireann díospóireacht -
Tuesday, 14 Jun 1988

Vol. 382 No. 1

Ceisteanna — Questions Oral Answers - General Medical Service.

13.

Tomás Mac Giolla

asked the Minister for Health if he will outline the latest position regarding negotiaitons with the Irish Medical Organisation regarding changes in the General Medical Service; if a draft agreement has been concluded and put before the Cabinet for approval; if it is intended to introduce a capitation system of payment for general practitioners in relation to medical card holders only; the measures, if any, he intends to take to ensure that this will not lead to the development of a two-tier system of medical care; and if he will make a statement on the matter.

43.

Mr. Keating

asked the Minister for Health if he will make a statement on the present position of the General Medical Service negotiations.

52.

Mr. P. O'Malley

asked the Minister for Health if he is recommending a capitation fee for general practitioners; and, if so, the reason.

55.

Mr. Allen

asked the Minister for Health if he will make a statement on the up-to-date position in relation to negotiations with the Irish Medical Organisation on a new contract with general practitioners for the administration of the general medical service.

Dr. O'Hanlon

I propose to take Questions Nos. 13, 43, 52 and 55 together.

Discussions regarding a new contract for doctors participating in the GMS scheme are continuing with the Irish Medical Organisation under the chairmanship of Mr. John Horgan.

It would be inappropriate for me to make a statement on the issues involved prior to the issue of Mr. Horgan's report. The Deputies can, however, rest assured that I will ensure that the quality of the service available to those covered by medical cards will not in any way be diluted.

Mr. Allen

May I ask the Minister if it is odd that this House cannot be informed of the details of the discussion when the Irish Medical Times of 3 June has detailed information on the discussions and negotiations between his Department and the IMO? Would the Minister confirm that the draft agreement between the Minister, the Department and the IMO will increase the commitment by his Department to the tune of £10 million and where will the money come from?

Dr. O'Hanlon

It is usual in negotiations of this nature between officials of my Department and any body, union or organisation that the details would be kept confidential. We made no release to the Irish Medical Times and I cannot vouch for the accuracy of the report.

Mr. Allen

Can the Minister confirm or deny whether the commitment will involve an extra £10 million of expenditure in the GMS?

Dr. O'Hanlon

That is part of the confidential negotiations.

Proinsias De Rossa

May I ask the Minister if he will ensure in the course of the negotiations that we do not end up with a two-tier system of health care at primary level whereby patients on medical cards would end up on queues for their general practitioners in the same way as they now have to queue up for consultants at present?

Dr. O'Hanlon

I can assure the Deputy that that will not happen. Indeed one of the issues which is being discussed, because the negotiations are based on the working party report on the general medical services, is how general practice might be improved to the benefit of all patients.

Mr. Molloy

Is it the Minister's position that he favours the capitation method of payment for general practitioners?

Dr. O'Hanlon

Yes, I believe that the capitation method or a capitation method with fees for certain procedures is the ideal way forward.

Mr. Allen

Will there be other incentives such as funded pension schemes adopted? Will there be other schemes besides the capitation fee? Will there be call-out allowances and week-end allowances? I believe that the capitation fee alone will result in a deterioration? There should be a multifacit agreement.

Dr. O'Hanlon

As I said I do not think it would be appropriate to go into details on the negotiations which so far as I am concerned are confidential.

Proinsias De Rossa

Would the Minister not agree that the introduction of a capitation fee system solely for medical card holders would, in effect result in an incentive for general practitioners to provide better care for private patients than for medical card patients? May I ask him also if the discussions which will take place will include discussions on the establishment of a drugs list or formulary of generic drugs for use by medical card holders only and if he will insist that such a list should be used for all prescriptions paid by the State?

Dr. O'Hanlon

I am satisfied that, whatever system of payment to the general practitioners evolves, we will ensure that there is equal treatment for all patients. There has been since the introduction of the GMS service and I have no doubt that that will remain the position.

Mr. Molloy

Would the Minister not agree that a capitation system of payment will operate to the detriment of the patient as there will be less incentive on the part of the doctor to treat patients? The fee per item system has operated successfully to the advantage of the patient. It must be recognised that there must be an incentive built into the system. If the Minister reverts to a capitation system surely he is removing that incentive which will operate to the detriment of the patient. Would the Minister clarify his views on this matter?

Dr. O'Hanlon

I would not accept that at all. In fact, I am surprised that the Deputy should make such a suggestion. If the Deputy looks at countries where there is a capitation system in operation patients do not complain that they are neglected or that they are not properly attended to.