Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "recognises that:

— access to effective and sustainable general practice services is a cornerstone of the delivery of healthcare;

— the Government, recognising the importance of general practice and acknowledging the challenges faced in some areas to maintain sustainable general practice services, has significantly increased investment in general practice in recent years;

— expenditure on general practice has increased from €561 million in 2019 to €784 million in 2022, with expenditure in 2023 likely to exceed €800 million;

— some areas are experiencing challenges in attracting General Practitioners (GPs);

— the implementation of the 2019 GP Agreement increased the Rural Practice Grant by 10 per cent, increasing the financial support to rural GPs;

— the Government has increased the number of GP training places from 258 in 2022 to 286 in 2023 and 350 in 2024;

— applications to join the GP training programme in 2024 reached the record-high level of 1,311 medical graduates;

— research undertaken by the Department of Health indicates that for every GP retiring over the coming four years one and a half to three GPs will enter practice;

— the Government has provided funding to the joint Irish College of General Practitioners/Health Service Executive (HSE) non-EU Rural GP initiative that resulted in the recruitment of 112 GPs from outside Ireland in 2023, with 75 already in place by year-end;

— the Government has provided funding to increase the number of GPs recruited under the non-EU Rural GP Initiative to up to 250 in 2024;

— Irish College of General Practitioners surveys have demonstrated that a large majority of GPs graduating from training intend to remain and to work in general practice in Ireland;

— the role of general practice is continually evolving to include new and innovative services, such as the Chronic Disease Management Programme which helps patients living with chronic obstructive pulmonary disease, asthma, chronic heart disease, and diabetes to proactively manage their conditions in the community, improving quality of life;

— the Government has put in place the resources to allow GPs to refer patients directly to diagnostic services, resulting in reductions in waiting times and earlier diagnosis;

— this Government has consistently made significant increases in expenditure on health services, resulting in an increase of 26,000 staff in the HSE, an additional 1,126 acute hospital beds, 25 per cent more intensive care beds, and a fall in hospital waiting lists for two years in succession in 2022 and 2023;

— there has been considerable additional investment in oral healthcare services in recent years, including an expansion in 2022 of care available within the Dental Treatment Services Scheme for adult medical card holders and a 40-60 per cent increase in fees paid to dentists across most treatment items; and

— sustained investment in recent years has reduced the numbers of children waiting to access public orthodontic care by 47 per cent between 2019 and 2023; and

agrees that:

— the Government is committed to fundamentally reforming dental services through implementation of the National Oral Health Policy, Smile agus Sláinte and that the HSE’s Strategic Reform Lead will drive service reform for adults and children in line with policy in 2024;

— increased investment is making general practice in both urban and rural areas a more attractive career prospect for medical graduates;

— the initiatives taken by the Government to increase the number of training places and to recruit non-EU GPs will result in an increase in the number of GPs providing services in both urban and rural areas; and

— the measures supported by this Government will result in an increase in the ratio of GPs to population and improved services for patients.".

I join the Rural Independent Group in offering my condolences to Deputy Collins and the extended Collins family, including his brother Councillor Danny Collins, on the death of his nephew. I am sure all Deputies will join me in expressing that sentiment.

I thank the Rural Independent Group for raising this important issue. I welcome this debate regarding the challenges with the provision of doctors, especially in rural communities. The programme for Government commits to transforming health and social services in the State in line with Sláintecare, recognising the importance of the expansion of community-based care to bring care closer to home. Access to effective and sustainable GP services is a cornerstone of the delivery of healthcare generally, and in particular the delivery of care close to the home and close to the people who need it. The Government is actively working to increase the number of GPs and GP access for patients throughout the country. We have significantly increased expenditure on general practice in recent years.

The Deputies spoke about the fact that it is not always cost effective for some doctors to run a service. In 2019, fees and other supports paid to GPs amounted to just over €560 million. In 2022, this increased to €784 million, with expenditure in 2023 likely to exceed €800 million, an increase of €230 million, or 41%, compared to 2019.

The 2019 agreement provided for a significant increase in expenditure on general practice, including a 10% increase in rural practice supports. Improvements to GP maternity and paternity leave arrangements were also made under the 2019 agreement. The 2023 GP agreement included a total financial package amounting to €130 million. This included enhanced capitation rates across various age groups and improvements in payments relating to the provision of contraception services under the GMS. The 2023 GP agreement also included measures to specifically support GP capacity, including €2 million to support GP out-of-hours services and a further €30 million in additional capacity supports to assist GPs to retain and recruit additional staff to meet patient demand. These measures make working as a GP in Ireland increasingly more attractive to doctors.

The number of GPs entering training has more than doubled from 120 in 2009 to 286 in 2023, and the Minister, Deputy Donnelly, has worked with the Irish College of General Practitioners, ICGP, and the HSE to further increase the number of places to 350 this year. We are already seeing the impact of the increase in training places in recent years. It is estimated that for every two GPs that currently retire, we now have three to six new GPs entering general practice. In addition, medical graduates are showing an unprecedented level of interest in general practice. A record number of 1,311 medical graduates applied for GP training in 2024. This notable increase, surpassing all previous years, underscores the strong interest in entering general practice among medical graduates and the growing confidence in the future of general practice. The ICGP has stated that the number of GP training graduates emigrating has been decreasing since 2017, with fewer than 6% of GPs now choosing to emigrate. I think everybody will welcome that.

As well as preparing for the medium- and long-term demand on general practice by increasing training places for medical graduates, the non-EU rural GP programme which commenced last year is already increasing the numbers of GPs in practices in the community. New doctors under the programme will work in general practice for a two-year period, following which they can take up an Irish GMS contract. The normal GP training period is four years. The initiative is targeted particularly at rural areas - Deputy Nolan referred to this in her speech - and those difficult to fill posts in various geographic locations across the country. This will further increase capacity in general practice and access to services in these areas. Some 121 non-EU GPs were recruited by the end of January 2024 under the training programme, with 84 non-EU GPs already in place in various practices across the country. The Government has provided funding to bring up to 250 more non-EU GPs to Ireland by the end of this year.

Notwithstanding the positive actions taken by this Government, I want to recognise that the provision of GP services in many areas has been challenging, including in some rural areas. The financial uncertainty associated with smaller panel sizes in some of these areas is often greater than elsewhere. Combined with the growing trend among GPs to seek to work as part of a multi-GP team in a larger practice, this can make it more difficult to fill certain GMS vacancies. When vacancies do arise, the HSE engages and takes all reasonable steps to recruit a GP to the vacant GMS panel. When a vacancy has not been filled before the departure of the existing GP, the HSE puts in place locum or other appropriate arrangements to maintain continuity of services. Rural practice supports increased by the 2019 GP agreement support GPs in these areas and help to increase the attractiveness of vacancies when they arise.

As of January there are 23 GMS vacancies across the country, approximately 1% of the total number of GMS panels. I am happy to report that the number of GMS vacancies fell from 34 in April 2023 to 23 in January 2024 as a result of HSE recruitment to vacant GP practices. Five of the vacancies that were filled were long-term vacancies, that is, vacant for over 12 months.

We all know that GPs are private practitioners, most of whom hold a GMS contract. I understand the points Deputies have raised. I am dealing with a situation in Lismore in Waterford where a doctor retired and the HSE advertised the contract. A person was offered the job but did not accept it so it has to be offered again. A locum is in place. When a locum is in place, patients do not build up the continuity they have with a GP who is serving over many years. I am sure we are all very familiar with what happens when a doctor retires or chooses to move to another area.

As I said, GPs are private practitioners, most of whom hold a GMS contract. In accordance with that contract, the HSE can assign medical card or GP visit card holders who have trouble finding a GP to accept them to a GP's GMS panel. People who do not hold a medical or GP visit card access GP services on a private basis and make inquiries directly to any GP practice. As we know, some practices are full and it has proven difficult for some to access them. I am working with a few people on this issue.

There has been considerable additional investment in oral healthcare services in recent years, including an expansion in 2022 of the care available under the dental treatment services scheme, DTSS, for adult medical card holders and a 40% to 60% increase in fees paid to dentists across most treatment items. Sustained investment in recent years has reduced the number of children waiting to access public orthodontic care by 47% between 2019 and 2023. The Government is committed to fundamentally reforming dental services through the implementation of the national oral health policy, smile agus sláinte. The HSE has appointed a strategic reform lead, who is driving service reform for adults and children in line with policy.

Finally, with respect to the future of general practice, in April last year the terms of reference for the strategic review of general practice were published. Following a delay in commencement due to the Covid pandemic, the review, as committed to in the 2019 GP agreement, is now underway. The Department of Health is leading on the review, with support from the HSE and input from key stakeholders, including the IMO and ICGP. The review will examine the issues affecting general practice, including GP training, GP capacity, out-of-hours services reform, the ehealth agenda, the financial support model for general practice and, of course, issues facing rural general practice.

The review will identify the arrangements necessary to improve the current system of GP care as part of a primary care focused health service and in line with the Sláintecare vision on access. This will include the consideration of innovative solutions, such as a possible role for HSE-employed GPs. As a result of the 2023 GP agreement, the HSE is already engaging with practices to develop a satellite surgery approach to ensure continuity of sustainable GP services within communities. The HSE is also looking at how it can improve locum support for rural GPs who have been finding it difficult to secure locum cover for holidays and other needs.

I looked at the figures of projected graduates over the next three years. In 2024, there will be 209 graduates. In 2025, there will be 226 and in 2026, there will be 257. It is estimated that for every two GPs that currently retire, we will have three to six new GPs entering general practice. In light of the above, it is the Government’s intention to propose a countermotion to this Private Members' motion, agreeing that the Government is committed to fundamentally reforming dental services; that increased investment is making general practice in urban and rural areas a more attractive career prospect for medical graduates; that the initiatives taken by the Government to increase the number of training places and recruit non-EU GPs will result in an increase in the number of GPs providing services in urban and rural areas; and will result in an increase in the ratio of GPs to population and improved services for patients.

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