I propose to take Questions Nos. 571, 572, 580, 581 and 589 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 aged 5 years and under with access to a GP service without fees. The implementation of this measure will require primary legislation, which I expect to be published shortly. A draft contract for the provision of free GP care to children aged 5 years and under, 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.
The Deputies' questions raised a number of specific issues, which I will now address.
The obligations set out in the draft contract in respect to the inspection of records by the HSE is a standard feature of most contracts for the provision of health and social services on behalf of the HSE. Among the circumstances in which they might need to be invoked would be where patient safety concerns arise; where concerns exist about the quality of services being provided; in processing complaints from patients/relatives; and for probity assurance purposes. In exercising a provision of this nature, the HSE would be obliged to have due regard to patient confidentiality considerations, the need for patient consent and applicable legislative obligations.
In relation to the limitation on the number of patients on a GPs list, a similar provision is included in the existing General Medical Services (GMS) contract.
Regarding visitation rates, research carried out for the Department in 2013 indicates that fee-paying children under 6 years of age have an annual GP visit rate of 2.7, whereas, medical card/GP visit card holding children in the same age cohort have an annual visitation rate of 3.1.
The term "medical practitioner " rather than "doctor" is used throughout the existing GMS contract and throughout the draft contract for the provision of GP care for children under six years.
I expect that issues such as increased visitation rates, the capacity of the existing number of doctors to deliver the service and the proposed five year contract will be the subject of further discussions with the GP's.