David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

acknowledges that:

— the survey of the career intentions of graduates of the four-year General Practice training programme, carried out by the Irish College of General Practitioners in mid-2023, showed that over two thirds (78.4 per cent) of recent graduates saw their future career in Ireland;

— General Practice is a vital part of our health service and needs to be supported and developed to ensure that patients have alternative care pathways to hospitals and Emergency Departments; and

— pharmacies can play an important role in ensuring patients get the right care, in the right place, at the right time;

notes that:

— many areas are experiencing difficulties in General Practitioner (GP) capacity, and this is leading to longer wait times;

— not all trainee GPs want to pursue independent practice and there is a role for directly hired GPs;

— the current GP contract is archaic and needs to be modernised to reflect the changing nature of General Practice and the need to expand multi-disciplinary Primary Care Teams; and

— pharmacies need to be supported to take pressure away from busy General Practice surgeries; and

calls on the Government to:

— establish a multi-disciplinary Working Group on the Development of Primary Care, with relevant stakeholder professions to guide strategic investment and deepen collaboration;

— increase the number of undergraduate, postgraduate and advanced specialist practice training places for Primary Care professions;

— develop a new public contract for GPs and launch a pilot programme in areas where there is a shortage of GPs for out of hours services and leave cover;

— increase the use of nursing and advanced practice therapy grades across Primary Care services; and

— invest in a "Pharmacy First" approach to minor ailments and move appropriate care from Primary Care practices to community pharmacies.

The purpose of the motion is to ensure that we provide the right care in the right place at the right time for patients. That was one of the core promises of Sláintecare. As I have said to the Minister for Health on a number of occasions, the problem we are having in our emergency departments, including again today across all our hospitals, not only in University Hospital Limerick, UHL, but in many of our major acute hospitals, is that we have had far too many patients on trolleys. We saw that again in the extraordinary numbers that were published today by the Irish Nurses and Midwives Organisation, INMO. Part of the reason is that we do not have the capacity in hospitals - we do not have the beds or staff - and it is partly because of what is happening in the hospitals. However, it is also partly because of what is happening outside the hospitals. Anyone who works in emergency medicine or any specialist who works in an emergency department will tell you far too many people end up going to an emergency department because they do not have any other option. The alternative care pathways are simply not there. If we are serious about really challenging, solving and addressing the unacceptable trolley crisis, we have to put more capacity into hospitals, but we also have to make sure people can access the right care in the right place at the right time and that is in primary and community care settings.

Much has been made in recent times - the Minister of State will have seen the commentary around it - of older patients being transferred out of hospitals. The difficulty is that many hospital managers do not have the option to transfer some patients safely because the step-down beds, recovery beds and convalescence beds are not there. We need more capacity in the community. Another big part of the problem, which is the substance of our motion, is that more and more people are waiting longer to see a GP. I attended a public meeting in Cahersiveen in County Kerry a few weeks ago. It was an area with Waterville in Kerry that had six GPs a few years ago. It now has two GPs of whom one is a locum. The other, a full-time independent GP who works there, will retire some time during the summer so the whole area of Waterville and Cahersiveen will be left with one GP. There is real concern among the population there, which has also increased in recent years, that people will be waiting much longer to see a GP. That is just one example. We can give many examples of that, not only in rural areas but also in urban areas.

We also are not making the best use of community pharmacists. I welcome that there have been some positive changes in this area in recent times. For example, pharmacists now have the ability to hold on to a prescription and extend it for a specified time without the person having to go back to a GP. That is for the good, but I have been calling for a pharmacy first model for some time that would allow pharmacies to manage and deal with minor ailments and be able to make prescriptions and better support general practice to take pressure off GPs and our hospitals.

The Government is not opposing the motion. I assume and hope this is because it agrees in principle with many of the recommendations made in the motion. It is time for the State to look at directly hired, salaried GPs. I have talked to a lot of young people who are in training colleges and want to be GPs. Some of them will want an independent practice and that is fair enough. Some of them do not, because they would end up being entrepreneurs and running busy practices which is not what they want to do. They want to be able to treat patients. In those circumstances, we could give them the opportunity to work for the State out of HSE centres and, in some cases, out of emergency departments, where that is necessary and would add value, and to provide locum and out-of-hours support. There is a whole range of options, but it is not something the Government has advanced or so far considered.

We have a crisis in general practice in some areas. We are not making enough use of community pharmacists and we do not have the care in the community, either in primary or community care, to manage older people or people with chronic conditions to the extent we should. All of that is lending itself to more and more people ending up going into emergency departments through no fault of their own because the alternative care pathways are not there. The recommendations we are putting forward with respect to general practice, community pharmacy, primary and community care are about making sure patients not only have options but also get the right care. This is also a big part of solving the problems in emergency departments and patients being on hospital trolleys. I thank the Government for supporting the motion. I want it to implement the recommendations contained in it.

See this speech in context