8 Mrs. Owen asked the Minister for Health the progress, if any, which is being made in the review of the General Medical Services Scheme; and the proposals, if any, he has made, or will be making, to the Irish Medical Organisation to avert the resignations of a large number of doctors from the scheme as and from 8th December, 1992.

70 Mr. Sherlock asked the Minister for Health the steps, if any, he is taking to settle the dispute involving general practitioners operating the General Medical Services Scheme in view of the very serious consequences for medical card holders of the threatened resignations by doctors from the service; and if he will make a statement on the matter.

137 Dr. G. FitzGerald asked the Minister for Health the steps, if any, he has taken to deal with the needs of medical card holders, particularly those with severe long term illnesses, in the event of general practitioners withdrawing from the medical card scheme.

138 Dr. Lee asked the Minister for Health the contingency plans, if any, he has in place in the almost certain event of the withdrawal of doctors from the General Medical Services Scheme on 1 December 1992; for the proper care and wellbeing of patients with medical cards.

I propose to take Questions Nos. 5, 8, 70, 137 and 138 together.

As Deputies will be aware, the GMS Review commenced in March of this year with the participation of the Irish Medical Organisation, the Irish College of General Practitioners, the Departments of Health and Finance and the health boards. Meetings of the Review are continuing on a regular basis and constructive dialogue has taken place on a range of issues. As the negotiations are at a delicate stage, I am sure Deputies will appreciate that it would not be appropriate for me to comment in detail on the nature of the discussions other than to say that both sides are committed to the review process.

I am hopeful, therefore, that it will be possible to bring these discussions to a successful conclusion and avoid a withdrawal of general practitioners from the scheme.

However, if the discussions reach a stage where it becomes clear that a withdrawal is inevitable, alternative arrangements will be put in place to ensure that medical card patients continue to receive GP services as well as necessary drugs and medicines. I wish to emphasise, however, that every effort is being made to resolve the current difficulties in the GMS through the process of the current review discussions.

Would the Minister accept that the amswer he has given today and the statements made in recent weeks do nothing but increase the anxiety particularly of thousands of elderly people dependent on the GMS system for their medical care? Will the Minister accept that it would be impossible for him or the health boards to put into place any comparable service should there be mass resignations of general practitioners? Would he accept the fact that hospital-based consultations amounted to 1.4 million last year while GP consultations amounted to 13 million and it is a nonsense to suggest that adequate and comprehensive cover could be provided for all patients currently dependent on the GMS scheme? Will the Minister end the confrontation now and enter into meaningful dicussions with the medical authorities and bring this dreadful situation to a conclusion rather than preparing contingency plans which will certainly be inadequate and will only further heighten the fears of thousands of unemployed and elderly people dependent on medical services.

First I would like to let the Deputy know that the resignation date is not until 30 November. There have been ongoing discussions.

They are getting nowhere.

An arbitration award of 17.5 per cent was offered to them.

But held back.

Let us hear the Minister.

They are very cross, and entitled to be.

They signed an agreement in 1989 on the basis of a whole new contract involving locum payments, superannuation, holiday leave, study leave as well as a number of ancillary benefits. Following that there were Programme for Economic and Social Progress increases. Following the operation of this scheme it was agreed by very many of the GPs that it was not working to their satisfaction.

It is two pounds per month per patient.

I thought the best answer to the problem was to have a complete review of this scheme.

That was agreed in 1989.

The management, that is, the Department, the Department of Finance and the health boards, prepared what I would call a blueprint for general practice to put it to the forefront of the health service. Indeed, I think this service would be much more cost effective than the hospital services. I hope they will study that blueprint so that it can be implemented.

I am not pessimistic yet and I believe we can reach an agreement. We will examine all aspects of the matter. I should say that even if the discussions break down and they withdraw, I still maintain that we will have to take emergency measures to ensure that those most at risk are not denied medical services.

The Minister will bring in the mercenaries.

I should say to all the Deputies in the House——

Order, please; we are dealing with priority questions.

——that none of us, on any side of the House, wants to see the service break down. I suggest, therefore, that we should not do anything that would inflame the situation but rather encourage them to continue the discussions——

Get down to serious negotiations.

——so that better benefits and working conditions are secured for general practitioners. Having been a general practitioner myself for many years, I more than anyone else in the House recognise the service that they provide. Therefore I am on their side and conscious of their needs and problems and I will do everything possible within my power to find a proper solution to the problem.

The Minister should make a realistic offer.

Let me ask the Minister a straightforward question. Would he agree that the GMS scheme is grossly underfunded and that if he was prepared to provide extra funding for the scheme there would be no resignations and the 1.2 million people who are covered by the scheme would be able to rest easy in their beds and homes during the next two months knowing that the service will not be withdrawn? Is the Minister honestly trying to tell this House that he wants to revert to the two-tier medical system where those who are not in a position to pay for their health care will have to queue at the old dispensaries? At least under the GMS scheme they can maintain some dignity. Would the Minister discuss the matter with the doctors realistically? As he is probably aware, it was reported in the Irish Medical News this week that the GPs committee expressed anger at him.

I should say that the time for dealing with priority questions is fast running out.

The time for dealing with this problem is fast running out also.

I should say to Deputy Owen that she would be an able advocate on behalf of those represented in the review process but if I was her I would not be too alarmed because — and she should believe me when I say this — every effort is being made——

The patients are alarmed and worried.

The doctors also tell us that they are alarmed.

People are alarmed in any situation where a trade union are negotiating with a Department.

This is quite disorderly in dealing with priority questions. As Members must be aware, only those Deputies who tabled questions are permitted to ask supplementary questions. Other Members——

We also represent medical card holders, a Cheann Comhairle.

Deputy Allen, you are excluded. I see no question here from you. Therefore, you are not allowed to intervene.

We understand but we are also concerned.

If you feel that you cannot obey those rulings I shall have to ask you to leave the House.

We also represent medical card holders and they are worried.

You know the rules of this House very well, Deputy.

We have had plenty of lip service but no investment by the Minister.

Deputy Allen, if I hear a further remark from you, you will leave the House.

I should say that every trade union involved in negotiations will naturally use every means at their disposal. Patients have been told by their general practitioners that the service will not be available after 30 November but I would not be too alarmed. We will continue to discuss this matter to see how this problem can best be resolved. At the moment it is not a crisis. I should also make the point that only 1,000 out of 1,600 doctors have sent in their letters of resignation.

The number is around 1,200.

Various figures are being bandied about——

That is cold comfort.

——but I would say that between 800 and 900 doctors have indicated that they wish to resign.

I spoke to Dr. McNamara about this issue.

Deputy Owen can take my word for it that about 800 doctors have indicated that they wish to resign.

The Minister is guilty of brinkmanship.

Even if the number was only 400 we must still try to resolve this problem and that is what we are trying to do. The House may rest assured that it will not be for the want of effort on my part if the service breaks down. The president of the Irish Medical Organisation has assured patients that those in need of urgent or emergency medical care will be taken care of by doctors. I wish to emphasise that point.

Is that life as distinct from health?

Patients are frightened.

I wish to make it clear that no patient's health will be put in jeopardy. I believe that Members will act responsibly and will not try to inflame the situation or to create undue anxiety on the part of medical card patients that their health may be put in jeopardy or that they may be denied their basic rights to medical care. This will be provided.

We must now proceed to other questions; Question No. 9.