asked the Minister for Health if he has any proposals to provide financial assistance for general practitioners who establish group practices in rural areas, and who wish to establish community health centres in order to provide emergency and basic medical services in addition to ambulance facilities.

The establishment of community health centres is a matter for each health board in the light of overall health priorities and in the context of available financing. I am satisfied that the new agreement with medical practioners in the GMS provides sufficient incentives to encourage the establishment of both group and partnership practices, where such groupings are seen to provide a more effective and efficient service to eligible patients.

The new agreement specifically provides for access to health centres, dispensaries and other health board accommodation to approved group practices and partnerships, together with enhanced fee payments for an extended range of special items of services and a continuation of the provision for payment of grants for practice premises development at the discretion of the health board. Assistance towards the cost of employing practice staff is also available to individual doctors or group practices.

While accepting the Minister's viewpoint that it is up to each health board to decide the level of their services, would the Minister not accept that there is a need for an overall policy from his Department in that respect; also that it is not practical for the majority of health centres to cater for a new rationalised service, particularly where there is a grouping of four or five doctors, and that the existing health centres are not adequate to cope with such a new service? In view of the earlier comments by the Minister in respect of community orientation and the need for a greater role by the general practitioners, would the Minister not accept the rationale of amalgamating existing individual group practices, existing GP services, in order to eliminate duplication, to provide easy access to second opinions, to enhance preventative medicine, to give better family planning services and overall to lessen the pressures on existing hospital facilities and outpatient services, particularly in the light of ongoing and impending hospital closures?

The new general medical services scheme will do exactly what Deputy Higgins would wish: it will improve the facilities for general practitioners to work from the fiscal environment and the thrust of the new scheme will support group practices and the integration of practices.

Would the Minister agree that the new scheme does not give any incentive to encourage the amalgamation of practices or the development of group practices, as suggested by Deputy Higgins? Would he also agree that if we are to give the kind of expert choice to the public in the community, as opposed to having them depend on hospitals, this is the only way to proceed? Would he further agree that many services could be carried out in GP surgeries for about 20 per cent of the cost of providing the service in a public hospital and that, therefore, there would be enormous savings to the Exchequer if we were to move in this direction?

As I stated in my reply to the specific question raised by Deputy Higgins about financial assistance for general practitioners who establish group practices, the new agreement specifically provides for access to health centres, dispensaries and other health board accommodation to approved group practices and partnerships. My reply to the specific question raised by Deputy Higgins is an indication of our support for group practices.

On the broader question raised by Deputy Harney, I would agree that ideally from the patients' point of view and an economic point of view, they should be treated at the lowest level of complexity for their particular illness. The number of special items for which a fee will be available will encourage doctors to carry out procedures that perhaps in the past patients were referred to hospital for. As Deputy Harney rightly pointed out, this would cost the Exchequer less.

They will have no choice because the Minister is closing the hospitals.