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General Practitioner Services Provision

Dáil Éireann Debate, Tuesday - 1 April 2014

Tuesday, 1 April 2014

Ceisteanna (96)

Billy Kelleher

Ceist:

96. Deputy Billy Kelleher asked the Minister for Health the action he proposes to take in view of the negative response of general practitioners to their proposed new contract; and if he will make a statement on the matter. [15121/14]

Amharc ar fhreagra

Freagraí ó Béal (12 píosaí cainte)

We have attended meetings at which general practitioners expressed concern about the contract the Government has proposed in the context of the roll-out of universal general practitioner care for children aged under six years. This is not universal care in the sense that somebody will have to pay for it at some stage. Persons with severe intellectual disabilities and serious and life threatening illnesses will pay for it. We seek clarity on the Minister's proposals.

The Government's vision for primary care is the development of a single tier system in which access is based on medical need, rather than ability to pay. The Government is, therefore, committed to introducing a universal general practitioner service without fees, on a phased basis, in its term of office. The word "universal" has the meaning of applying to everybody and does not touch on the issue of how care is funded. It means simply that everyone has access. As such, the distinction drawn by the Deputy is incorrect. Perhaps we will return to that issue.

The orientation of health systems towards primary health care and general practice has advantages in terms of better population outcomes, improved equity, access and continuity of care and lower cost. As announced in the budget, the Government has decided to commence the roll-out of universal general practitioner services by providing all children under six years with access to a GP service without fees. The decision to commence the roll-out with this age cohort is in accordance with the recommendation in Right from the Start, the report of the expert advisory group on the early years strategy. Universal screening and surveillance services are already made available for children in this age cohort. Evidence suggests that a high quality primary care system with universal access will achieve better outcomes for young children.

The implementation of this measure will require primary legislation, which is expected to be published shortly. The necessary administrative arrangements will be made when the specifics of the legislation are known. The introduction of this service also requires a new contractual framework to be put in place between the Health Service Executive and individual general practitioners.

As Deputies are aware, a draft contract is currently the subject of a consultation process. In excess of 280 responses were received by the Health Service Executive during the consultation process. These responses are being examined and a report will be published in due course.

While there has been some negative reaction to the draft contract, I am pleased to say the Irish Medical Organisation, the primary representative body for general practitioners, has confirmed it is supportive of Government policy to introduce GP care free at the point of access, albeit conditional on the provision of adequate resources and full and meaningful negotiations with the IMO. I welcome this response and I have assured the IMO, most recently in my letter of 26 March, that the Department and the HSE are prepared to engage meaningfully with it in negotiations on all aspects of the scope and content of the proposed contract. I have also explained that there will be an opportunity for its input on the fee structure, which will be addressed by means of a complementary consultation process.

Additional Information not given on the floor of the House

I trust the IMO will accept my invitation to commence negotiations with the Department and the HSE. This will afford it the opportunity to obtain clarification from the Department and the HSE on any aspect of the draft contract and to raise any other issues which it may have in that regard. I am confident a process of open discussion has the potential to significantly enhance the draft contract for patients, GPs, the HSE and the Department, thus helping to progress our common goal of free GP care at the point of access.

The Minister of State said at the outset that he has a vision for primary care, but it became clear as he neared the end of his reply that he has no vision because there are no actual plans in place to deal with what the Government committed to in its programme for Government. It is evident there has been no increase in funding in respect of primary care and that the continuing withdrawal of discretionary medical cards is what is funding the roll-out of free GP care for children aged under six years. For this not to be the case would have required the Government to increase the budget over and above what is currently provided. The Government has not done that. There has been a systematic reduction in terms of the availability of discretionary medical cards to people who held them based on illness and need owing to medical conditions.

The Minister of State said a consultative process was in place. There has been no consultation with GPs. The contract was published by the Minister, the Minister of State and their officials with no consultation on the matter. Had there been some consultation there might have been an embracing of the contract. As I understand it, there has been no embracing of this contract by GPs. It is an onerous and restrictive contract which forces GPs to choose between people who hold medical cards and those with discretionary medical cards, granted to them based on illness and need rather than age.

What Deputy Kelleher said is incorrect. The Government has a clear plan in relation to the implementation of access to free GP services for children under six years of age. The legislation in this regard will be published shortly. I look forward to hearing the Deputy's response to that legislation because I am anxious to know whether he supports the initiative. The IMO has indicated it supports it, although it has raised reasonable concerns which I am anxious to discuss with it.

The Deputy is also wrong on the budgetary issue because €37 million has been voted specifically for this measure. The Deputy is also wrong in his commentary about discretionary medical cards being granted to people based on medical need. The Deputy knows well that there is no such thing as a discretionary medical card based on medical need but that people may apply for and the HSE may grant a discretionary medical card in circumstances where a person has to meet expenses in respect of their medical condition.

I look forward to meeting the IMO. It has been suggested there has been no attempt by me to ensure such a meeting takes place. I have written twice to the IMO. I am engaged in correspondence with it, which I could read into the record of the House if I had time. I have made it clear to the IMO in that correspondence that I look forward to meeting it. I have extended three invitations to the IMO to meet me to negotiate on the contract. There will be consultation and negotiation but people have to attend a meeting for this to happen.

Not only is the Minister of State playing with words, he is playing with people's lives when it comes to discretionary medical card withdrawals. Time and again when we have raised the issue of discretionary medical cards in this House, the response has been that there is no such entity as a discretionary medical card. Up until last year, every HSE service plan made provision for discretionary medical cards. Provision in that regard was always included in the HSE budget. We now find it has been removed from the lexicon of the Department in terms of primary care funding. While provision was always made for discretionary medical cards, they are now being systematically withdrawn.

Last Sunday week was International Down's syndrome day. Families of children with Down's syndrome are time and again highlighting that they are unable to obtain or renew discretionary medical cards. Some 50% of families in this country have lost or cannot get a discretionary medical card based on medical need. That is a fact.

The Deputy is making up figures or pulling them from the sky.

The Deputy asked a question to which I have responded. If he wants to have a discussion on discretionary medical cards I am happy to do so.

There is no mention of that in the Deputy's original question, which refers to what he calls the "negative response of general practitioners to their proposed new contract".

I clarified what I meant.

It is interesting that Deputy Kelleher almost always moves off the subject of free medical care for those under six years of age, even when the question he tables refers to them. The Deputy spent no time discussing those to whom I refer and instead tried to deflect the House's attention towards another matter.

What about the position with regard to those with long-term illnesses?

We are quite happy to discuss discretionary medical cards. The Deputy is wrong. There is no systematic policy, or anything like it, to remove discretionary medical cards. The Deputy is well aware of what I meant when I stated there is no such thing as a discretionary medical card. A medical card is a medical card. Regardless of whether one applies through the means-tested system or the discretionary system, what one will obtain is a medical card. The cards relating to both systems are the same. The Deputy knows what I am talking about and it is he who is playing fast and loose with the facts.

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