On behalf of the Rural Technical Group, I call Deputy Harty.

On behalf of our group, I express our horror at another terrorist attack on defenceless people, this time in Turkey.

Will the Tánaiste address the status of the negotiations between the Department of Health and the IMO on developing a new GP contract that will allow for the development of a new GP-led primary care model to drive change in our health service? The present contract is 44 years old, outdated and increasingly unworkable. It was introduced to replace the dispensary system, which itself was 100 years old. Thus, the basic contractual structures of Irish general practice have changed only once in the past 160 years, which seems difficult to believe. The present contract was introduced in 1972 to provide acute care for the most vulnerable patients who had medical card entitlements. We have moved a long way in those 44 years and modern general practice has developed beyond the confines of the contract, yet it remains constrained by it.

The future of modern general practice should include providing and leading the management of chronic and acute illnesses. As our population ages, people's complex care increases due to their development of multiple degenerative diseases and cancers. The burden of care for these chronic diseases will be best and most cost-effectively provided in GP-led primary care rather than in the more expensive hospital setting.

The present contract requires GPs to provide 24/7, 365-day services. Most contract holders are working in excess of 60 hours per week. GP workload is increasing due to our ageing population and the eventual extension of free GP care to cover the entire population. Waiting lists to see GPs are developing for the first time, as general practice capacity is being overwhelmed by the increased workload. A new contract is required to expand that capacity and allow general practice to cope with the increased workload of delivering chronic disease management and free GP care to all children. Indeed, it is open to question whether giving free care to healthy children rather than patients with established chronic illnesses is the best way to spend scare resources.

Hear, hear.

If we have a GP service that is constrained by an outdated contract and unable to deliver chronic care in the community, our hospital system will be further overwhelmed. We will face the prospect of rising trolley counts, increased accident and emergency unit overcrowding and increased hospital waiting lists.

Will the Tánaiste assure the House that negotiations are being pursed as a matter of urgency and indicate a target date for their completion? It is imperative that, as a first step in planning our health care reform, the Government develop and build a modern, GP-led primary care service that is underpinned by a new GP contract.

I thank Deputy Harty. I certainly agree with the last statement that he made, namely, that we need a new GP contract and the service to be underpinned properly by that. Under the framework agreement that was entered into between the HSE, the Department of Health and the IMO in June 2014, a process was agreed under which the parties could negotiate on all publicly funded health sector contracts, including general practice and General Medical Services, GMS. In this context, the parties have committed to negotiations on a new GP contract to replace existing arrangements. These talks have commenced. The Deputy will be aware that the Minister for Health has met the representative bodies. He has had very good individual meetings with both of them, but I agree as well with what the Deputy said, namely, that we need to plan ahead, given the ageing population that we have. People are living longer and their needs will be greater and more diverse. We also have the highest birth rate in Europe. Huge pressures are building up on GP services.

We have increased the health budget in recent weeks. We have made very clear in this partnership Government our commitment to primary care. There is a clear consensus that is the best approach for patients. We need to look at how to advance that. We have the all-party health committee and we have the agreement in respect of rural practices that was reached last year.

I am informed by the Minister for Health that he intends to consult and engage further with the stakeholders in primary care in the autumn, hopefully in September. This engagement will include GPs, dentists, pharmacists and others to consider how best to ensure joined-up thinking, greater integration and the world-class integrated primary care service that we absolutely need around the country.

Deputy Harty said that during the negotiations on the programme for Government, we agreed on building GP capacity to respond to patient needs, for example, by providing access to X-rays, ultrasound and other investigations and through the expansion of chronic disease management in general practice. We have made progress but it will require additional GPs. Recruiting GPs remains a challenge for the health service. We will need to identify the clear pathways for patients from GP care to hospital care, etc.

There will be further discussions from September onwards. The Minister is hopeful in this regard, and we have made progress. We have 90 primary care centres across the State, with 47 having been delivered in the past five years despite the economic circumstances. Another 80 will be built by 2021. We have delivered free GP care to children under six. However, we want to see progress being made on the GP contract.

I would like the Government to address a number of issues concerning the contract. There are four main issues resulting in considerable pressure in general practice. One is the application of the FEMPI legislation. It was applied to general practice in a very disproportionate manner. Some 40% of the support structures to finance general practice were removed under FEMPI, which was unfair. This has had a devastating effect on general practice.

The second aspect is that the contract needs to be flexible. A one-size-fits-all contract will not help general practice. We need flexible contracts, part-time contracts and, perhaps, salaried GPs.

Third, there is a manpower crisis in general practice. Some 20% of GPs are over the age of 60 and will retire soon. Our new graduates are not coming into general practice because of the unattractive nature of the contract. Established GPs are leaving the country to move to more attractive areas.

Finally, our out-of-hours services are struggling to cope with the lack of indigenous GPs and locum GPs to man them.

On the Deputy's point on the recruitment of GPs, it is not just a national issue but also an international one, as he will be well aware. Every effort is being made regarding this. A higher number of training places has been agreed in recent times.

With regard to the FEMPI legislation, it is the Government’s intention to unwind as much of that in as timely a way as possible. That brings itself to bear on GPs in addition to others working in the public sector. Clearly, the Summer Economic Statement outlined a very strong economic position that I hope will continue to put the Government in a position to improve conditions. Central to that is a positive outcome to the GP contract negotiations. I hope they go well. Everybody is committed to ensuring we will have the new GP contract. As the Deputy stated, it is out of date and we need to conclude a new one.

That concludes Leaders' Questions. In light of the points raised by Members, I invite everyone to stand in his or her place for just one minute as a mark of respect to those who have lost their lives in Turkey.

Those of us who were not in the House would like to be associated with those points.