Mr. John Hennessy:

I thank the Chairman and members of the committee for the kind invitation to attend the committee meeting.

I am director of primary care, and I am joined by my colleagues, Dr. David Hanlon, GP and national clinical adviser for primary care, Mr. John Hayes, chief officer of community health care area 1, Mr. Pat O’Dowd from our contracts division, and Mr. Ray Mitchell from our parliamentary affairs division.

This meeting provides an opportunity to update the committee on some of the measures the HSE is taking to ensure appropriate health and social service delivery in rural areas. The HSE is committed to ensuring patients throughout the country have access to appropriate health care, including primary care and general practitioner services, especially in rural areas, and that general practice in particular is sustainable in such areas into the future.

The development of primary care services continues with 484 primary care teams identified throughout the country covering the entire population. This means that there is a dedicated group of HSE staff assigned to each geographic area who work closely with GP colleagues to provide services for the population. The aim is to provide services in local communities in order that people can be maintained in their own homes and communities for as long as possible.

The GP and the primary care team represent the key point of service delivery to address the majority of the medical and social care needs of the population. Primary care teams comprise a range of health care professionals, including GPs, nurses, occupational therapists, physiotherapists, speech and language therapists, health care assistants, and home help staff. Primary care networks provide additional resources depending on assessed need, such as social workers, dieticians, psychologists, audiologists and community ophthalmic physicians.

The development of primary care teams is a work in progress with enhancements occurring in terms of team membership and organisational delivery over time. At present, just over 3,100 staff are directly employed in primary care teams, comprising nursing, therapy and support staff, together with approximately 2,800 contracted GPs and 2,100 practice nurses. More than 300 additional clinical posts have been added since 2013, including public health nurses, registered general nurses and therapy posts.

On the capital side, primary care centres continue to be developed in all parts of the country, with many rural areas benefiting from new primary care centres in recent years. The HSE continues to work closely with local GPs and HSE staff to develop the most appropriate facilities for such teams.

I wish to mention island services. A review of health services to island communities is under way. This is chaired by my colleague, Mr. John Hayes, chief officer, and has representation from the Department of the Arts, Heritage, Regional, Rural and Gaeltacht Affairs, the Department of Health, the Irish College of General Practitioners, local GPs and island community representatives.

Cross-divisional representation from the HSE is also included, namely, mental health, health and well-being, acute hospitals, social care, nursing and the National Ambulance Service. Recommendations will be made on how high-quality, accessible and safe services should be provided in the future in a more integrated, sustainable and cost-effective manner. The group is expected to report its findings in January 2017. Consideration will be given at that stage to providing more primary care services locally and improving communications. Tele-health options will be explored as part of this to enhance the provision of services such as follow-up appointments by video conference and to enable island health professionals to work more effectively with specialist services and other members of the primary care team. The development of an island nurse job specification and enhanced training for nurses on islands is also being considered as part of this.

Support for rural general practice is one of the priority agenda items under the current review of the GP contract. It is recognised that we need to strengthen and widen the supports available to GPs in remote areas. An early example of progress on this was the introduction of a new rural practice support framework in May 2016. Under this framework, some 306 GPs have benefited already; this is an increase of 139 GPs in 2016. The allowance is now worth €20,000 per annum, plus maximum practice supports for the employment of practice nurses, secretarial support, cover for annual leave and medical indemnity insurance. In total, we estimate the value of the rural practice framework to be approximately €45,000 per annum for general practice. The purpose of the new guidance, aside from expanding the number of practices covered, is to ensure consistency, transparency and fairness in decision-making regarding rural GP practices, as well as providing additional options to support GPs. It should also be noted that a dispensing GP is entitled to receive an additional payment for dispensing medicines where there is no pharmacy accessible.

A number of other contractual changes have also been introduced recently including the introduction of free GP care to children under six and adults over 70, a cycle of care for patients with diabetes, an asthma cycle of care for children under six, periodic health assessments for children and a revised schedule of special items of service for which an enhanced payment is now payable, including 24-hour blood pressure monitoring. The option of flexible contractual arrangements where GPs can share the whole-time commitment required under the GMS contract, which is effectively job-sharing, has also been introduced and the extension of the retirement age under the GMS to 72 is in place also at the discretion of the GP. Further recent developments have included a scheme to provide direct GP access to diagnostic ultrasound examinations, which is of particular benefit to the west and south of the country and the development of minor surgery capacity in general practice.

GPs have demonstrated in all of this a willingness and capacity to embrace change. I look forward to further fruitful discussions in the coming months aimed at further enhancing the range and quality of GP services, to include especially the expansion of integrated chronic disease management in primary care. The HSE is keen to ensure that its approach to future contract discussions is informed by contributions from the widest possible network of stakeholders, including members of the public and public representatives. In this regard, it will be commencing a comprehensive public consultation process in the coming weeks. This concludes my opening statement. Together with my colleagues, we will endeavour to answer any questions you may have.