Dr. Madeleine Ní Dhálaigh:

The Deputy's question is a good one. As we all know, the effect of emigration down the years across the board has been multi-factorial but what all younger GPs saw when they went abroad were highly functional systems of care in both primary and secondary care. Primarily we are doctors and we want to work in really high-quality systems. It is very difficult for them to come back to Ireland and see this quite broken system of care. One issue is very close to my practice because I specialise in women's health. The way other countries such as Australia deliver women's healthcare is fantastic. The underinvestment that has been the case for decades in this country has been informed culturally, which is something we all know a lot about. We should be leaving this culture behind. The recent highlighting of menopause care and the ad hoc approach in this country was very welcome because it was something GPs had been talking about for a long time but menopause care is just one aspect of women's healthcare. We need to look after our women and girls from adolescence through to their child-bearing age and menopause. Regarding the very specific example of menopause, those are highly complex, individualised consultations that GPs are not funded to do under the GMS system so we are doing them on a pro bonobasis. They are not once-off consultations. We need to see these women on a regular basis and we need to be dynamic in and individualise their care.

I am an early abortion provider in a rural community in Castlerea, County Roscommon. This has shed light on a very difficult hidden fact in Irish women's healthcare, namely, that working poor women will never prioritise their healthcare needs above those of their children and families. We see a high proportion of women who are unable to afford good-quality contraception so they now find themselves with unplanned pregnancies. Thankfully, they can now access care in Ireland. We really need to look after women and girls from the time of adolescence right through to contraception for all women who need it and really high-quality menopause care. To bring it back to the question about emigration, for me looking at other countries and coming back to this healthcare system, that is a really good example of how emigration has affected us.

Regarding corporatisation, in other countries, GPs can access retirement planning and feel very comfortable with it. The corporates are probably the only area that offers retirement planning. The State needs to sit up and take note because there is a place for them in certain circumstances but our current model should not be dismissed. Again, our rural colleagues have given significant service to this State and worked onerous rotas in very isolated practices single-handedly.

While it is important that we move towards group practices, we have to acknowledge what they give. We cannot throw the baby out with the bathwater by taking away rural services and moving them into group practices. We need a hub and spoke model and we need to continue to provide dynamic, responsive rural care. During the pandemic, we could see how our rural colleagues stepped up in very isolated situations. We need to acknowledge that.