We hear that at Cabinet yesterday a proposal to allow GPs to opt out of the scheme to bring free GP care to the under-fives was discussed. Today, Dr. Ray Walley of the IMO described the scheme and the Government's approach as courting disaster. I and other Deputies recently met with a large group of Wicklow GPs who described the proposal as a mistake. They explained that there is no extra capacity to deal with the extra visits in which this will inevitably result and that in consequence, other patients with more pressing medical or financial needs will either not be seen or will wait much longer to be seen. They predict that children will be brought to them who do not need to be seen, leading to other people who do need to be seen not being seen. They could not understand why the under-fives as a group are being targeted ahead of those who are either in greater need of medical care or cannot afford it.

What the Government is doing does not make any sense. With one hand, it is clearly taking medical cards away from people who desperately need them and with the other, it will give GP cards to many people who do not need them. What GPs are saying is that this will lead to yet more waste in a very wasteful health care sector, with GPs seeing people who do not need to be seen and, therefore, not seeing patients who do need to be seen.

It is clear that the GPs were not consulted in any meaningful way as this plan was put together. The scheme and the approach that the Government has taken is further alienating a GP sector that is crying out about what is already happening in primary care. The GPs pointed out that there are very few young GPs entering the sector, that three out of every four graduating GPs in Ireland are emigrating and that the GPs who are here are advising their colleagues not to come home because of what is happening in primary care and general practice. They explained that the HSE embargo has exacerbated this situation and pointed out that there is a six-month wait for physiotherapy appointments in Wicklow.

Based on common sense, the fact that medical cards are clearly being taken away from people who need them and what appears to be a very solid consensus from the GPs, does the Taoiseach agree that this scheme should be shelved and that money in health care should not be directed using a carte blanche approach but to those who either cannot afford the care or need it most?

I do not agree. Deputy Donnelly is wrong when he said that this matter was discussed at Cabinet yesterday. There was no discussion about the under-fives or GP care at Cabinet yesterday. The Government made a clear decision to introduce free GP care for under-fives in 2014 as the first of a number of major steps leading to universal health insurance. Every parent and grandparent knows the costs of dealing with family life are now very expensive. They include mortgages, the burden of crèche fees and so on. All these hardworking parents of children in 240,000 families will now have the reassurance that they can bring their children to the doctor without having to pay for each appointment. Moneys were allocated in the budget to deal with this. There was additional separate funding of €37 million for the introduction of this key reform. It is a fully costed estimate based on current rates of reimbursement to GPs under the GMS scheme and includes capitation fees, practice support costs, other claim costs and out-of-hours costs. It is an essential part of the movement towards universal health insurance, was costed by Government and will cover 240,000 families. The parents of those children can have the comfort of knowing they will not have to pay when they go to their doctor for that GP visit.

Deputy Donnelly is also incorrect when he says that the situation regarding medical cards has changed. There has been no change in the criteria for the allocation of medical cards and extra moneys have been included for the provision of new cards this year, as one would expect.

I have heard the Taoiseach make the claim many times that there has been no change in medical card policy but every Member of the House knows that there is clearly a change on the ground. If we go back to Irish Water, the argument is that one has to charge for water because it is a publicly provided good and if it is free, people over-use it. That is the economic argument. We must charge people money for their water. GP care is a publicly provided service as well but here we are being told that it will now be free. We know from recent research that the average number of visits per year to a GP from people who do not have medical cards is three and that for those who have medical cards, the average number is eight.

I am not against reducing the cost. I believe that it should be affordable and that it is not affordable as of now. The GPs are unambiguously saying that if this is made free people will significantly over-use our finite service so they will end up spending time with people who do not need their service, which will take time and medical care away from people who do need it.

The GPs are telling us that general practice in Ireland is in crisis. A total of €160 million was withdrawn from the sector in the past four years. Today the IMO said that many general practices around the country are on a financial precipice. The GPs I met have said that they have had a 33% cut in public funding and a 50% cut in profits to their general practices. There is a false economy at work. I would love GP care to be free - I have two children under six - but it should not be free for those who cannot afford it, rather it should be affordable. Why is the Taoiseach going to direct finite and scarce health services to people who the GPs are saying will over-use them and who do not need them when the Government is taking medical cards away from others? I apologise if the matter did not come up at Cabinet yesterday. Is the Taoiseach, therefore, saying that there will be no opt-out for GPs from this scheme?

I do not know whether the GPs in Wicklow who met Deputy Donnelly speak for all the GPs in the country. The reason the Government made this decision is very clear. It is the Government's intention to move to the introduction of universal health insurance. The first step in doing that was to move to free GP care for the under-fives in 2014. The reason the decision was made as clearly as it was is that it will benefit 240,000 families with children who are hard-pressed in many circumstances with mortgages, crèche fees and other charges that apply as part of normal family life. An extra €37 million has been allocated to the scheme and takes into account all the general costs that apply under the GMS scheme for GPs. I am sure that the GPs in Wicklow, who no doubt do a very good job as do other GPs, are aware of this. That is the reason we made the decision.

In October 2013, 1,863,984 full medical cards were granted and another 124,337 people received GP cards. That is an increase of almost 590,000 full medical cards since 2008. Last year, the HSE awarded 100,000 medical cards, of which over 23,000 were discretionary. Extra money was allocated for new medical cards in this year's budget. The anecdotal evidence the Deputy cites is true in some cases but it is most certainly not true in all cases.