Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity to engage with colleagues on the important matter of the provision of primary care health services. Access to health services in the community is essential to people's well-being, with GPs usually acting as people's primary care providers and gatekeepers to the wider healthcare services. Treating patients as close to home as possible is beneficial for patients and for the wider health services as it reduces pressures on hospitals.

The programme for Government recognises the importance of expanding primary and community care. One important commitment is to strengthen general practice and increase the number of GPs working throughout the country to accomplish this. The Government has increased the attractiveness of working as a GP by significantly increasing investment in general practice in recent years. The 2019 agreement included more than €211 million in additional investment for general practice, providing for an almost 50% increase in capitation payment rates for GPs and a 10% increase in rural practice supports. Improvements to GP maternity and paternity leave arrangements were also made and a support for practices in urban areas of deprivation was introduced. The 2019 agreement also introduced the GP chronic disease management programme, which has since been fully rolled out, as committed to in the programme for Government. The programme helped GMS patients with chronic diseases to be cared for as close to home as possible, in GP clinics and community settings, and avoid the need for hospital attendance.

Separately, the 2023 GP agreement included a total financial package of €130 million. The agreement further enhanced capitation rates across various age groups and enhanced the payments for the provision of contraception services under the GMS scheme. The 2023 GP agreement also included measures specifically to support GP capacity, including €30 million to assist GPs to retain and recruit additional staff to meet patient demand.

The effect of these measures, which make working as a GP in Ireland more attractive, is reflected in the record number of 1,311 medical graduates who applied for GP training in 2024. The number of doctors entering GP training has been increased each year from 2019 by approximately 10%, rising to 286 places for new entrants in 2023. The Minister for Health, Deputy Donnelly, has engaged with the HSE and the ICGP to provide for a further increase of 22% on last year, to 350 places, for 2024.

The ICGP's recent graduate survey, to which reference is made in the motion, reports that retention of GP graduates is extremely high, with 96% of GPs surveyed who graduated between 2017 and 2022 found to be working in general practice in the State. As stated by the ICGP, the improved financial environment for general practice and the variety of career options has made general practice a very attractive career for graduates.

To increase GP numbers more rapidly, the Government has co-operated with the ICGP and the HSE to introduce the non-EU rural GP training programme. This programme recruited 112 non-EU GPs last year. The Government has provided funding to bring up to 250 more non-EU GPs to Ireland by the end of 2024. The programme targets the placement of GPs to rural and underserved areas, increasing access to services for these communities.

The enhanced community care, ECC, programme established in 2019 aims to improve patient care by delivering increased healthcare provision in the community and thereby also reducing dependency on the hospital system. Under the programme, care is reoriented towards general practice, primary care and community-based services to help enable an end-to-end home first care approach. The Government has allocated €195 million in recurring annual funding to the ECC programme for the establishment of 96 community healthcare networks, 30 community specialist teams for older people and 30 community specialist teams for chronic disease, as well as national coverage for community intervention teams and the development of a volunteer-type model in collaboration with the Alone charity. All 96 community healthcare networks are operational, as are 53 of the 60 specialist teams. In total, more than 2,800 staff have been onboarded, with 3,500 staff ultimately to be recruited into the ECC programme.

Since its commencement in January 2021, the GP access to community diagnostics programme has facilitated GPs to directly refer patients for radiology diagnostic scans at convenient locations in the community. The programme provided more than 339,000 directly referred scans in 2023. The Government has provided funding of €46.9 million in budget 2024 to continue the programme with full adult population access. Furthermore, we have provided funding of €22.7 million in the waiting list action plan 2023 for identified HSE community initiatives, with a focus on orthodontics, primary care child psychology, counselling in primary care, primary care therapies and CAMHS. Work is currently under way to develop a primary care waiting list management protocol to ensure a more consistent focus on understanding and addressing these waiting times.

The pharmacy task force established last year to support the expansion of the role of pharmacists is continuing its work. Expanding the role of pharmacists can help mitigate demand on other service providers and further move care into the community. The initial report of the expert task force was published last November and the first recommendation implemented from 1 March. The first recommendation empowered prescribers to write 12-month prescriptions for patients where clinically appropriate and following certain criteria. This reduces the demand on GPs and other prescribers for repeat prescribing. The task force is now focusing on recommendations regarding pharmacists prescribing within their scope of practice. A report with associated recommendations will be published by the Department of Health before the end of the second quarter.

The Government has taken measures to increase third level student places across health-related disciplines and thereby increase health workforce availability, including that for community services into the future. In collaboration with the third level sector, the Government has provided for more than 660 additional student places in medicine, nursing and midwifery, pharmacy and other key healthcare courses in the academic year 2023-24. This includes more than 220 student places across nursing and midwifery and allied health professional courses in Northern Ireland. Some 25 additional medical places are being made available for qualifying students from Ireland or Northern Ireland in Queen’s University Belfast in September 2024, with a further 25 places to be made available in September 2025. The number of doctors enrolled in training programmes has been increased by 25% in the past five years, with a 23% increase across basic specialist training intakes and a 26% increase across higher specialist training intakes. Some 13 higher education institutes are currently providing publicly funded undergraduate nurse and midwife education. For the 2023-24 year, an additional 259 undergraduate nurse and midwife student places were made available, resulting in an overall number of 2,332 available student places in first year of the programme across these HEls.

The Government has also invested heavily in advanced practice for nurses and midwives in line with the prioritisation of community care, including chronic disease management, older persons' care and waiting list management. Budget 2023 provided funding to recruit an additional 80 whole-time equivalent advanced nursing and midwifery practitioners during 2023. Some 69 of these have already been onboarded and further recruitment is planned for this year. As of January, there were 1,132 advanced nursing and midwifery practitioners working in the health service. These measures highlight the significant work of the Government to provide improved community healthcare and GP services.

While the GMS contract has been significantly updated through the recent GP agreement with the IMO, a strategic review of general practice is under way to examine the issues facing it and to set out the measures necessary to ensure a more sustainable general practice service. This will involve a further modernisation of general practice. The review is examining issues relating to capacity, out-of-hours care and e-health, among others. Particular consideration is being given to the suitability of salaried GP roles and mechanisms to attract GPs to underserved areas.

It is the Government's intention not to oppose the proposed motion. The Government fully recognises the important role of general practice and has provided significantly increased support for the provision of the GP services. The number of student places for health-related disciplines, including nursing, has been increased. The number of doctor training places, particularly GP training places, has also been greatly increased. Provision has been made to increase the number of advanced nursing and midwifery practitioners and consideration of how to further expand the role of pharmacists to provide community services is well under way. These measures show the Government's commitment to improving patient care at the local community level and the very real steps taken to that end.

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