I thank the Deputy for the question, the answer to which I might integrate with my response to Deputies Connaughton and O'Connor. The IMO is aware that a manpower issue is looming. A generation of GPs who entered the General Medical Services, GMS, in 1972 are due to retire within the next five to seven years. I want to debunk the theory that the IMO has been opposed to the opening up of the GMS and complicit in the suppression of lists. Since May, we have had an agreement with the Secretary General of the Department of Health and Children and the chief executive officer of the HSE to carry out an in-depth audit of manpower needs in general practices in a structured manner.
It is important to point out that the Department's policy has been to reduce the numbers involved in the GMS. Since 1989, the Department has been of the opinion that it does not want many small GMS panels, since they are expensive to service and do not help with the delivery of services using a teamwork approach. While we agree in this regard, there should be a structured management of the opening up of the GMS.
Last week, we met the HSE's national managers. They discussed deregulating the GMS, carrying out mapping exercises in a remote office and picking a magic list of 12 black spots around the country where there were no GPs. According to our national GP committee meeting last night, lists are being suppressed by the HSE around the country. While I will not name the areas on the list, I will happily inform members in private. Where an existing panel holder in a provincial town had a list of 1,200 GMS patients, a new viable list of 400 GMS patients was advertised without consultation with the IMO. An interview panel was set up. No female practitioner held a medical card listing in the town in question. A number of people were interviewed, including two well qualified, young, female GPs, one of whom had been a principal in a general practice but had retired for a short time for family reasons. However, that list of 400 was given to the single-handed practitioner who had the 1,200-patient list.
We are annoyed and angered. Despite making it clear that we want more GPs, particularly younger ones, to be brought into the system in a structured way so as not to destabilise it and to allow the management of GP numbers, we meet national managers of the HSE and they tell the media that the IMO is suppressing lists. This is an untruth. I have given a specific example, but there are other examples of viable lists being suppressed in the past 12 months in the north east and some urban areas. This has been done at the behest of local HSE management to reduce costs and for managers' convenience, as they would not need to support a new practice starting up. It does not help the situation.
While manpower is an issue, we should not panic. Within the current framework of interviews and appointments, much can be done in co-operation with the IMO to alleviate many of the stresses. Last May, we committed to this process, but are still seeking a meeting with the Department and the HSE to progress the matter. We know that there is a crisis and everyone around us is discussing it, but the Department and the HSE have not seen fit to progress it in spite of an agreement with the Secretary General, the CEO of the HSE, who was also present at the meeting in question, and the CEO and president of the IMO. I want to make this clear.
We oppose the complete deregulation of the GMS, as any young doctors would set up in non-viable situations. We had a bitter experience in the 1980s when many young doctors were unsupported, worked from converted garages at the side of their houses and had no nursing or secretarial support. A similar situation will not address what the State and citizens need from GPs.
We welcome the HSE's initiative to ring-fence €200 million to lease primary care buildings in which GPs can operate to facilitate the roll-out of the primary care strategy. We have encouraged our members to become involved and have advised them to take the best legal estates, accounting and business planning so as to make the centres sustainable. The last thing we want is for people committing to the building of premises and discovering in four or five years, after the State, GPs and perhaps developers have made a considerable investment, that the model is not sustainable. It is important that the initiative start on a sound footing. We are heartened by the national estates manager, Mr. Brian Gilroy, who seems to have taken a pragmatic approach. We understand that, in times of economic stringency, funds are limited, but this important initiative should be followed through because of its importance.
Deputies O'Connor and Connaughton asked how many people can be kept out of hospital. GPs working in isolation cannot keep one extra person out of hospital, but GPs in teams and who are enabled to carry out a greater breadth and depth of service in the community can. Everything from the management of chronic inflammatory diseases, infusion services and haemochromatosis to warfarin services can be carried out in the community, but GPs in the current model are often doing so at a cost to their practices and themselves if they are committed to the services. Money does not follow the patient to the community.
No one would expect hospital consultants to provide a service in isolation. Rather, they have teams of nurses, allied health professionals and administrators to help. However, GPs are expected to provide a service at a moment's notice. If there is an influenza epidemic, one sees one's GP. One rings a GP the next morning if one has a breast cancer scare. There is no recognition of the fact that 100,000 consultations occur everyday in general practice with little complaint. There are few complaints because general practice provides equal access to public and private patients, a valuable element in the current GMS contract that should be kept.
The IMO did not agree with the hospital co-location policy. After being told by the Minister that it was the only show in town, we decided that we may have to——