Progress made in the universal GP care plan

The Government is committed to introducing, on a phased basis, a universal GP service without fees within its first term of office, as set out in the Programme for Government and the Future Health strategy framework.

This policy constitutes a fundamental element in the Government’s health reform programme. There has been no change to the Government’s over-arching commitment to this goal. This Government is the first in the history of this State to have committed itself to implementing a universal GP service for the entire population.

Having examined the progress made in the universal GP care plan, it became clear to me that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic for a short-term arrangement. Relatively complex primary legislation would be required in order to provide a GP service to a person on the basis of their having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable in order to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, and who could do this, and how to select the diagnostic basis for medical conditions. As well as primary legislation, there would be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve this, it would take several months more to finalise the primary legislation, followed then by the preparation of statutory instruments. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

The Cabinet Committee on Health has discussed the issues relating to the delay in the initial step of the roll-out of the universal GP service. In doing so, it has considered the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other hand, the need to bring forward an important Programme for Government commitment with the minimum of further delay.

No decision has been taken by the Cabinet Committee or by Government on changing the first step of the plan to extend GP care without fees to persons with chronic illnesses. Instead, it has been agreed that we should prepare and set out a number of alternative options with regard to the phased implementation of a universal GP service without fees.  Minister Reilly and I expect to report back to the Cabinet Committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service. 

The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent Budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this Programme for Government commitment.