Hildegarde Naughton (Galway West, Fine Gael) | Oireachtas source

I also begin by adding my condolences to those of others to Deputy Michael Collins on the loss of his nephew.

I thank Members of the House for their contributions to this discussion on general practice in rural communities and for their interest in and commitment to the issue. I acknowledge the issues various Members raised, such as the delays patients are facing in getting appointments with GPs and some GP practices not currently accepting new patients.

The Government has substantially increased investment in general practice in recent years in an effort to increase GP capacity. Expenditure on fees and other supports paid to GPs has increased by 41% since 2019, with expenditure in 2023 expected to exceed €800 million. These fees and supports include a 10% increase to rural practice supports, improved GP maternity and paternity leave, and enhanced capitation rates. It also includes increases in payments for the provision of contraception services under the GMS, €2 million to support GP out-of-hours services, and a further €30 million in additional capacity supports to assist GPs in retaining staff and recruiting additional staff to meet patient demand. These measures are making general practice an attractive option for medical graduates, as can be seen in the record levels of applications to enter GP training in 2024 and the decreasing number of GP training graduates who now intend to emigrate.

It is acknowledged, however, that the provision of GP services in some rural areas is more challenging than in others. The pattern of work in general practice is changing and there can be financial uncertainty in setting up a practice in a rural area as the size of the GMS panel available may be smaller. GPs increasingly favour a multiple-GP team model, with some GPs developing sub-specialisations such as in chronic disease management or women's health. While the overall anticipated increase in GP numbers is expected to help to address the challenges of service delivery overall, including in rural areas, it is accepted that some difficult to serve areas require additional supports to ensure access to general practice services in the community. To address this, the 2023 GP agreement included specific supports for rural practices. In addition to the 10% increase in rural practice supports, a ring-fenced fund of €600,000 is being made available to support the delivery of an initiative to support rural GPs to source locum cover for approved leave periods. The HSE is currently exploring how to implement this solution. The HSE is also in the process of implementing a programme to improve the sustainability of GP services in rural areas by working with a larger practice in a nearby town to take on a smaller practice as a satellite entity. It is hoped that, if successful, the programme could be rolled out elsewhere and help to ensure the ongoing provision of services in rural communities. These are examples of creative solutions which will make rural general practice more attractive to GPs. Increasing GP training places will increase GP capacity in the medium to long term, and the number of GPs entering training has more than doubled, from 120 in 2009 to 286 in 2023, with a further increase to 350 places planned for this year.

While there may be some concern that the planned retirements of some GPs will result in GP capacity issues, the replacement rate for retiring GPs is very encouraging for the future of general practice. Due to the increased number of GP training places over the past several years, it is estimated that for every two GPs who currently retire, we now have three to six new GPs entering general practice.

As regards more immediate measures to address rural GP capacity, the non-EU rural GP programme is already placing GPs in rural practices across the country with 121 non-EU GPs recruited by the end of January 2024, of which 84 were already in place in GP practices. The Government has provided funding to bring up to 250 more non-EU GPs to Ireland by the end of this year. The strategic review of general practice is under way and 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 programme for Government and the Sláintecare vision of access.

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 for adult medical card holders and substantial increases in fees paid to dentists. Sustained investment in recent years has reduced the number of children waiting to access public orthodontic care. The Government is committed to fundamentally reforming dental services. The HSE has appointed a strategic reform lead, who is driving service reform for adults and children in line with policy.

The Government is committed to delivering the enhanced community care programme, which is designed to deliver the reorientation of service delivery towards general practice and community-based services, thereby providing health services closer to people's homes - the right care in the right place at the right time. Therefore, I support the Government's amendment to this motion, which agrees 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 for medical graduates and 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, in an increase in the ratio of GPs to population and in improved services for patients.

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