Dáil Éireann díospóireacht -
Wednesday, 15 Dec 1999

Vol. 512 No. 7

Written Answers. - General Medical Services Scheme.

Brian O'Shea

Ceist:

30 Mr. O'Shea asked the Minister for Health and Children if he will provide a breakdown of the allocations to the development of general practitioner services under the national development plan; his position on the establishment of a primary care insurance scheme; the action, if any, he will take on the estimated 200 general practitioners who are not allowed access a GMS list; his views on the introduction of tax breaks to provide general practitioners with the financial wherewithal to develop group practices and to upgrade their facilities and working infrastructure; if he will allow general practitioners equality of access to diagnostic facilities located within hospitals; the plans, if any, he has to develop general practitioner primary care units at each major hospital to foster efficient use of accident and emergency departments; and if he will make a statement on the way in which he envisages the development of the role of the general practitioner within the health service. [27069/99]

Minister for Health and Children (Mr. Cowen)

This question covers a number of related but sep arate matters. There will be a significant development of general practitioner services under the national development plan commencing next year. The exact level of allocation that will fall specifically to general practice development is currently being finalised in my Department in the context of a number of particular projects and strategic goals.

The Government position on private health insurance can be found in the recently published White Paper which contains a section on primary care insurance, Paragraphs 5.36 to 5.45. The White Paper states that the Government considers that the further evolution of private health insurance should include steps to promote the position of primary care in the system and have regard to the particular role that general practitioners are positioned to play in maintaining and improving the health awareness and status of the public. Legislation is currently being prepared in my Department to give effect to the White Paper's conclusions and recommendations and such legislation will, it is scheduled, be introduced next year.

In March of this year, an agreement was reached with the Irish Medical Organisation, in the context of extending medical card eligibility for the over 70s, on the issue of so-called excluded doctors, that is, doctors who did not have a GMS scheme contract. That agreement provided for a one-off scheme of entry to the GMS scheme for doctors in practice on 1 March having the requisite qualifications and required experience on that day or subsequently. Those arrangements are now operating and I have no plans for further action in this area.

The matter of tax is one for my colleague, the Minister for Finance, but my Department and the health boards have provided, and continue to provide, funding for general practice development through the GP capital fund and the GP development fund. The indicative drugs target savings scheme provides an additional source of finance for general practice developments. General practitioners already have considerable access to hospital diagnostic services. In each health board area, the question of further developing access is kept under ongoing review and I am satisfied that this is the best way to proceed.

There have been a number of developments in the provision of general practitioner services aimed at reducing utilisation of hospital accident and emergency services. Health boards have sought to develop effective GP rota systems so that patients can easily contact a GP for their needs outside of normal surgery hours. Some health boards have now gone beyond the rota systems by encouraging the development of specific out of hours GP co-operatives which are managed and operated by local GPs to serve patient needs on a virtual 24 hour basis. CAREDOC in the Kilkenny/Carlow area is such an example and the North Eastern Health Board is launching a board wide pilot project next year along similar lines. Both CAREDOC and the NEHB initiative are being monitored and will be reviewed to see whether they can be extended, over time, to the rest of the country. In other cases throughout the country there are already GP or primary care operated facilities located in hospital complexes, for example, DUBDOC in Dublin which operates from St. James' Hospital. Such hospital based arrangements, like the rotas and co-operatives, are monitored to establish how well they meet patient needs and reduce dependency on other health services.

I am concerned that there should always be the most effective use of healthcare resources and I see the general practitioner continuing to play a central role in healthcare delivery in the context of an integrated healthcare sector where appropriate linkages are fully developed between primary care providers and other health service providers. I see this being done in partnership with general practitioners.