Stephen Donnelly
Ceist:1. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the negotiation of a new general practitioner contract; and if he will make a statement on the matter. [17265/18]
Amharc ar fhreagraThursday, 19 April 2018
Ceisteanna (1)
Freagraí ó Béal (7 píosaí cainte)
I look forward to working with the Minister in the coming months and for however long this Dáil lasts. My intention and that of Fianna Fáil is to work with the Government on the issue of healthcare where we can, although, as I am sure the Minister will appreciate, we will robustly hold him to account where we believe there is not sufficient action being taken. I certainly extend the hand of co-operation to the Minister and the Government. There is obviously much important work to be done across the country in the area of healthcare, on much of which we agree in terms of what needs to change. One of the areas in which there is a need for change is general practice. The GP group has reached tipping point. We are all aware of the very serious challenges being faced by patients in the community and GPs who, financially and in terms of having a work-life balance, are under enormous stress. Many are leaving the profession. There are numerous challenges. A key component in fixing this problem is beginning negotiations on a new GP contract as soon as possible. Will the Minister report on progress in getting the negotiations under way?
I congratulate the Deputy on his appointment as his party's spokesperson on health. We obviously know each other well. It is a great day for Greystones and County Wicklow, with such great emphasis being placed by us on healthcare. I, too, look forward to us working together. As a much more accomplished politician than I once said, "I wish you luck but not too much." I also very much extend the hand of co-operation. There is much on which we all agree - Sláintecare being the most obvious and important blueprint. I look forward to working with the Deputy in the many months and years ahead and being held to account in this House on the important issues.
I thank the Deputy for his important question. I note that he attended the IMO conference recently, as I did, at which we both heard clearly that general practice in this country was in need of a significant investment. It is fair to say that, like many parts of the public service, it suffered significantly during the years of recession. Decisions that had to be made by the Deputy's party in government on the FEMPI legislation and decisions made by mine starved it of much needed resources.
I made it clear at the conference that I intended to commence negotiations with GP organisations at the end of this month. The purpose of the negotiations is twofold. The first purpose is to ascertain what we must do to ensure general practice in Ireland can be sustainable into the future and what is a fair fee to pay for the services general practices are currently providing. As the Deputy will be aware, I now have powers, given to me by this House under legislation passed by the Minister for Finance, Deputy Paschal Donohoe, last December, which allow me to set fees. The second purpose is to ascertain what can general practice do, if we are willing to resource it to do more. We have all heard about the exciting things GPs want to do in terms of access to diagnostics, working as part of the primary care service, interacting more with the hospital setting and taking some work out of it and into the community, but they can only do this if they are resourced to do so. The Government wants and expects to spend many millions of euro more in general practice in the next few years and wants to start doing so quickly. I hope, with intense negotiations that can commence by the end of this month, we can make progress to that end in the coming months.
I thank the Minister for his co-operation.
I thank the Minister for his response. I hope all sides can come to the table in the next few weeks because I am not entirely sure the GP population and the patients they serve will be able to take much more. As I see it, the relationship between GPs and the HSE and between GPs and the Government is at an all-time low. There is no trust, at least as expressed to me by GPs and their representative bodies. They are deeply suspicious. What would help and go a long way early on is a reversal of the FEMPI legislation. Obviously, it must be unwound in a fiscally responsible and affordable way. We are aware that it is being reversed for us, as politicians, civil servants, nurses, NCHDs, consultants and teachers, but GPs have been left out in the cold. Will the Minister put together in the coming days, as a gesture of genuine good faith towards GPs, a roadmap for how the FEMPI legislation will be unwound because many GPs are saying it is all well and good that the Government is stating it will consider the issue but that it cannot take any longer than three years? Is the Minister able to commit to putting a roadmap in place for the unwinding of the FEMPI legislation as a matter of urgency as a gesture of genuine goodwill as the new negotiations start?
I expect that we will, as part of the engagement on general practice, put together a roadmap to move to a post-FEMPI legislation era. I am glad that the Deputy mentioned other healthcare professionals because he is entirely correct. We have begun the process of unwinding the difficult FEMPI legislation pay cuts for all public servants, including other staff working in the health service, but, as the Deputy will also be aware, we did so as part of a process. I hear from GP organisations - I disagree with them - that one could reverse the FEMPI legislation with the stroke of a pen, but that would not be fair to nurses, speech and language therapists, physiotherapists, porters and everybody else who works in every other element of the health service. I want to move beyond the FEMPI legislation. I want to be able to pay GPs a fair fee for the services they are providing that reflects the better economic situation. I also want to spend a great deal more on general practice. We are training more GPs than we did in previous years. For example, in 2009 there were only 120 GP training places. This year it is expected that there will be 194, an increase of 60%. The challenge is to ensure that when those GPs come out of training they will want to stay here to work in general practice. We need a new contract to do this. We need to move to a post-FEMPI legislation era. I have the support of the Government, including the Minister for Finance and the Taoiseach, to put real resources behind this move to a much better place.
GPs are concerned the Government will unwind the FEMPI legislation as part of the contract negotiations. We all know that in a new world of integrated primary care the role of the GP will become more prominent, more important and better funded but much more will be asked of them. It is fair to say that while there was a quid pro quo in the unwinding of the FEMPI legislation for teachers, nurses and civil servants, there was not such a substantial rethinking of their roles, as teachers, educators or nurses. GPs will be entering a different conversation because their fundamental role in the community will change and become more prominent. The fear is that the new contract could take several years to negotiate - it may well do - and that the FEMPI legislation may not be unwound until it is in place.
This is why I asked that as a gesture of good faith, the beginning of an unwinding of FEMPI might be considered very quickly. For example, will the Minister consider putting a budgetary allocation in for 2019 as a partial unwinding of FEMPI for GPs?
I appreciate the question raised by Deputy Donnelly and I am sure he appreciates the position I am in where I cannot negotiate on the floor of the House. I expect that we will be investing many millions more in general practice from 2019 and that we will be beginning to move post FEMPI in 2019 subject to us being able to agree a myriad of things we need to discuss. In any negotiation, both sides will have things they want to discuss. GPs are very clearly saying to me, the Government and this country that they cannot do more unless the existing services are made sustainable and that requires additional investment. I hear that so we must get that right at the start of the process. However, they also want to have a conversation, which I also want to have, about how we make things like Sláintecare a reality. Quite frankly, we cannot do it, as the Deputy correctly says, without involving the GP, practice nurses and the entire primary care team and without resourcing it to do so. I see the conversations as interlinked. How do we make current services sustainable? This involves a discussion about moving to a post-FEMPI era. How do we also then resource, pay and fund general practice to do more? These talks will commence at the end of this month.