Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputies for the questions. They are exactly the right questions. I made my position on this very clear in the past; general practice does not have enough capacity. The contract was signed more than 40 years ago and a new one is urgently needed. Some very good work was done to augment the existing contract, including moves towards the management of chronic disease in the community. That was done in consultation with the Irish Medical Organisation, IMO, and general practitioners. It was a very useful step in the right direction, but it does not take away from the fact that we need a GP contract that is fit for purpose as part of modern universal healthcare. That contract must significantly increase resources for general practice and must increase the role of general practitioners in the community in line with Sláintecare. Sláintecare essentially calls for all possible care to be provided within the community, in or near patients' homes.

I fully agree that we need more GPs. We do not have enough. I fully agree that more needs to be done to make the profession more attractive. That must include maternity cover, increases to the rural allowance and other measures, many of which have already been outlined in Sláintecare. The 2019 agreement sets out significant increases in practice implementation. My understanding is that it is on track, as is the increase in funding. We also need to work with the Irish College of General Practitioners, ICGP, to increase the number of available training places. We are engaging with that issue.

The debate now concerns the next three sections, which essentially concern the expansion of GP care to various age groups. We are meeting with the IMO to address exactly these questions. I do not want to prejudge the conversation but as Deputies know, my previously expressed opinion is that we do not have sufficient capacity. Simply expanding entitlement without expanding capacity does not work. There are no winners with that approach. As such, we are asking the House to pass this Bill so that we have the legislative framework which to date has not been in place. It is hoped it will be passed by this House this evening and by the Seanad tomorrow. Once the legislative framework is in place, we can immediately begin to discuss these capacity constraints with the IMO so they are tackled in a phased manner. That is why this has been structured in three phases. Immediately expanding free GP access from children under six to children under 12 would not be wise from a capacity perspective for the very reasons the Deputies have outlined. That is why we are taking a phased approach.

I fully agree with the sentiment expressed by the Deputies. We need to expand resourcing, training, GP numbers and the support available to GPs. We need to introduce a new GP contract at the same time so the reforms are joined up. We also need to be very aware of just how crucial the role of GPs will be this winter. We will need to tease out the additional demands on GP services with the IMO. GPs really stepped up when Covid-19 hit. They went to an awful lot of effort to keep people out of hospitals. Services like e-prescribing were introduced overnight. That was not possible before.

Regarding winter planning, I note that resuming services and getting through the winter with Covid-19 will require GPs to continue to step up and work as part of an integrated system. This is the joined-up view outlined by Sláintecare. We must keep patients out of hospitals. That will mean working with GPs to find different care referral pathways. That is the approach we will take.

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