Holly Cairns (Cork South West, Social Democrats) | Oireachtas source

I want to extend my sympathies to Deputy Michael Collins on the tragic loss of his nephew. My thoughts are with Michael's family and friends and the wider community.

I am grateful for the opportunity to talk about the provision of healthcare and GP services in rural areas. In Cork South West, we are very familiar with the pressures on and failures relating to health services in rural communities. The blunt truth is that the current GP model is not working and has not done so for a very long time. The GP contract is more than 40 years old and is completely unfit for today's world. It requires GPs to set up private practices. The medical work of GPs is hard enough without their also being forced to deal with the pressures of running a small business. It puts medical graduates off the role. In 2019, an ICGP survey showed that only 26.9% of graduates wanted the responsibility of running a small business.

The HSE cannot just keep hoping that this problem will fix itself. We need an alternative model. The HSE has to take responsibility for community healthcare and provide salaried HSE positions for GPs who want to do the work, but do not want to take on the incredible workload of running a practice. We also need to see multidisciplinary GP teams, consisting of nurses, pharmacists and healthcare assistants all working together within general practice, to be built up. This is especially important in the context of rural areas.

There are GP practices in my constituency that are two hours away from the nearest trauma centre, obstetrics unit and surgical unit in Cork city. Putting that pressure on lone GPs is completely unfair and unrealistic, and puts patients at risk.

Out-of-hour GP services throughout the country, but especially in rural areas, are running on a skeleton staff. A salaried model would mean that salaried GPs could work those out-of-hours shifts instead of the expectation that GPs who are already running services during the day, potentially five days a week, would also do that work at night on a completely ad hocbasis. It would also offer a flexibility that GPs do not have at the moment and would include basic things such as part-time contracts, four-day weeks, the option to work a couple of evenings per week, maternity cover and holidays. GPs need a better work-life balance and this is the measure that would provide it.

We cannot keep expecting doctors to carry on like this. Last year, Dr. Fiona Kelly, a GP in my constituency in Castletownbere, tried to take her first holiday in over a year. She tried everything she could to get cover but could not and was forced to close her practice for the day. That is the level of pressure GPs are under. They are never able to take a holiday or sick day or take a break without having to cancel appointments for patients. These working conditions are ridiculous. Dr. Kelly told the Irish Examinerthat a typical day for her means dealing with 70 to 100 patients, with consultations in person, by email and on the phone. The European Union of General Practitioners recommends that the safe level of patient contacts per day is no more than 25. A salaried model would also make it a much more attractive career for young people. A serious concern in GP services is replacing local GPs as they retire. More than one quarter of GPs in Cork and Kerry are over 60 and it is incredibly difficult to replace them in rural areas because of the pressures to provide those out-of-hours services. When these practices lie empty and when SouthDoc services, such as those in Skibbereen, close their doors and reduce their hours, it is a recipe for disaster that forces people in medical emergencies to travel even further to reach an open clinic in areas in which a person would have to wait a long time for an ambulance.

Everyone in rural Ireland knows the pressure GPs and out-of-hours services are under, but what does not help is the absolute lack of transparency on the part of the HSE with respect to these reductions in services. Last summer, when I was first informed that patients from Skibbereen and its surrounding areas were being diverted to Bantry for SouthDoc, I was at my wit's end trying to get a straight answer from the HSE. Officials from the executive swore there was no reduction in services in Skibbereen SouthDoc while the call centre operators were telling my staff they had been diverting patients to Bantry for weeks. These are vital services in rural areas and the absolute least that communities deserve is clarity around the operational status and their capacity. Healthcare must be available to everyone 24-7 regardless of their postcode, but it is getting more and more difficult every year to access medical care and pharmacy services out of hours in west Cork.

This all comes down to a complete absence of Government planning and investment, which has brought the service to a crisis point. The GP training programme needs to be massively expanded. Figures released to Deputy Shortall last September showed that of 964 eligible applicants for GP training, only 286 were taken on. That is disgraceful. We are crying out for GPs throughout the country and nearly 700 potential GPs are being turned away from training.

Another health service under considerable pressure in rural areas is dentistry. There are currently only two public dentists serving the whole area of west Cork: one in Bantry and one in Clonakilty. I am contacted repeatedly by desperate parents whose children are in pain and cannot access dental care. The Bantry clinic is under extreme pressure with cuts, forcing it to operate on a three-day week with staff expected to cover the entire west Cork peninsula. The situation is desperate. We need to provide affordable dental care to people in our communities. It used to be that children in west Cork would see a school dentist in first, third and sixth classes. Appointments are now only available for those in sixth class. Are primary school children supposed to wait eight years for any dental treatment?

There is a severe shortage of dentists participating in the schools scheme. In response to a recent parliamentary question, the HSE told me there were 28.3 full-time equivalent dentists serving 380 schools across Cork. That is tens of thousands of children being covered by 28 dentists. Is it any wonder parents cannot get appointments? The HSE seems to be blaming the failing services on a lack of private dentists participating in the scheme, which is another example in the long list of the State outsourcing its own responsibilities to the private sector.

The HSE needs to provide these services itself with public dentists. This all comes down to a complete absence of Government planning and investment, which has brought rural health services to a crisis point. I know there is a strategic review of GP services ongoing and I join my colleague Deputy Shortall in appealing to the Minister of State to include the possibility of salaried GPs in that review. The Government needs to act quickly to increase capacity in the GP and dentistry systems, to make the professions more accessible to young doctors and to ensure GPs can access cover when needed.

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