Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

There is all this talk about a plan without an engine. My problem is that I do not see the plan. We can put an engine in place later but there is no plan there at the moment for general practice and that is the big problem. Indeed, we have been talking about this at this committee for a long time. There is no workforce plan in existence and that has been the huge gap and the reason we are now struggling. Even though money is being provided for different new services, we cannot recruit and money goes unspent. The biggest challenge within the health service is having a realistic and meaningful workforce plan.

There is a lot of talk about rural areas with a lack of GPs. As somebody who represents a disadvantaged urban area, as indeed the Chair does, we are acutely conscious that there are vast tracts of disadvantaged areas in urban Ireland that do not have GPs. The inverse care law says that the more health services are required, the less likely an area is, if it is disadvantaged, to have them. The model just does not work for disadvantaged areas because the buildings are not available and people cannot invest in local buildings.

In trying to get to the root causes of some of these logjams, there is something we have not talked about yet, which is the policy on the funding of medical schools. That policy is contingent on medical schools taking in large numbers of non-EU students, in particular. The fees for non-EU students are enormous. The funding model is based on substantial receipts from those students and that operates to the disadvantage of Irish students who are trying to get in; including the kind of students the Chair was talking about. We do not have a shortage of people who want to work in healthcare. There are these logjams along the way. Thousands of school leavers apply to get into medical school and they do not get in because there are not sufficient places. A large percentage of those places goes to people who pay big fees to bring money into the medical schools. That has not been referenced and it is a significant factor.

The other issue is why graduates are not staying here after they qualify. What research has been done on that? I asked a group of graduating GPs a number of years ago if they would stay in Ireland if there were premises provided for them and the vast majority said they would. They said they would be more than happy to do that. We know, and Dr. Farrell said himself, that after a long training they have loans to repay and all so on, and the vast majority of them are not in a position to fund premises for themselves. The Chair mentioned this. Whatever about people from less affluent backgrounds getting into medical school, they certainly do not have money to get a premises. This has been opposed by a lot of GPs who have invested in their own premises down through the years. I understand people being concerned and not wanting the model to change. Does Dr. Farrell accept that there can be two different models? There is the model that a GP invests in him or herself maybe in a group practice or that kind of thing but there has to be a different model, which is a State-funded premises that can be used so that newly qualified GPs can go into and work in those premises. Does Dr. Farrell accept that many GPs graduates want to be employed in premises provided by the State?