Peter Burke (Longford-Westmeath, Fine Gael) | Oireachtas source

I would like to thank Sinn Féin for raising this discussion on primary care health services. The Government acknowledges there are issues in delivering healthcare in some communities, including issues regarding access to care for GP services in certain areas. However, the actions of this

Government to improve service provision over the longer term will lead to significant improvements in the delivery of patient care within communities. Indeed, we have addressed most of the points raised in this motion.

The Government has substantially increased investment in general practice in recent years with a view to increasing GP capacity. In 2019, fees and other supports paid to GPs amounted to just over €560 million. This increased to €807 million in 2023, an increase of €247 million, or 44%, when compared to 2019. This increase was largely provided for under the 2019 GP agreement. The agreement increased GP capitation fees; increased supports, including the rural practice support; and introduced a support for practices in urban areas of deprivation.

The 2019 GP agreement also introduced the very well-regarded GP chronic disease management, CDM, programme, which has since been fully rolled out and expanded upon under the 2023 GP agreement. As of 1 January 2024, in total, almost 400,000 patients have been registered to the CDM treatment programme and GPs and practice nurses have conducted over two million chronic disease patient reviews under the programme from end January 2020 to end December 2023. Building on the GP element of the CDM programme, patients can now also access services for their conditions from the 53 specialist older persons and chronic disease teams that have been established under the enhanced community care, ECC, programme.

I will say more about that in a moment. The Government's investment in general practice will increase further following last year's GP agreement.

The 2023 agreement provides for payments for the provision of GMS contraception services, €30 million in additional capacity supports for practice staff, as well as €2 million to further support GP out-of-hours services. Both interest in GP training and the actual number of GP trainees has increased in recent years. 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 provided for in 2024. The latest ICGP GP graduate survey highlighted the high retention of GPs after graduating, with 96% of those surveyed who graduated between 2017 and 2022 found to be working in general practice in Ireland. Based on the increases made to GP training places and expected GMS GP retirements, work undertaken in the Department of Health indicates that between three and six GPs will be onboarded for every two GMS retirements over the next few years.

The Government is committed to delivering the enhanced community care, ECC, programme, to enable the reorientation of service delivery towards general practice and community-based services. Under the ECC programme, all 96 community healthcare networks are operational, as are 53 specialist teams for older people and for chronic disease. Some 2,800 staff have been onboarded, with, ultimately, 3,500 staff to be recruited into the ECC programme. Since 2021, the GP access to community diagnostics, GPACD, programme has facilitated GPs to directly refer patients for radiology diagnostic scans in the community. The programme provided over 339,000 directly referred scans in 2023 and the Government has provided funding to continue the programme with full adult population access in 2024. In addition, we have provided funding of €22.7 million in the waiting list action plan 2023 for identified HSE community initiatives.

The Government is also conscious of the need to increase the number of healthcare professionals working across the health services, and, in particular, the need for Ireland as a country to ensure we are providing training places sufficient to meet this demand. In collaboration with the third-level sector, the Government has provided for over 660 additional student places in medicine, nursing and midwifery, pharmacy and other key healthcare courses in the academic year 2023-24. The number of doctors in training has increased by 25% over the past five years, a 23% increase across basic specialist training intakes and a 26% increase across higher specialist training intakes. Undergraduate nurse and midwife education places have also been increased.

With the financial support of the Sláintecare integration innovation fund, the UCD pilot graduate diploma in primary care nursing practice was established to provide an education programme that specifically supports general practice, primary care and community nurses and midwives in the reorientation of care towards the community. Commenced in September 2023, 27 community registered general nurses, CRGNs, and 33 general practice nurses enrolled in the pilot course. Increases in healthcare-related high-level education places and in doctor and nurse training places will help provide for our healthcare workforce into the future, including for the provision of primary care and community care services.

The Government also recognises that Irish pharmacies play an important role in the provision of care in the community, and to that end, the Government is committed to enabling the optimisation of pharmacy services and pharmacist practice. The pharmacy task force was established last year to make recommendations on expanding the scope of the practice of pharmacists. The first recommendation of the pharmacy task force, to empower prescribers to write 12-month prescriptions for patients, where appropriate, was implemented on 1 March. A report with further recommendations regarding pharmacist prescribing will be published by the Department of Health by the end of the second quarter.

The Department of Health and the HSE commenced the strategic review of general practice last year. The review, with input from relevant stakeholders, is examining the broad range of issues impacting general practice. The review will examine some of the issues raised in the motion in relation to the modernisation of the GMS GP contract, capacity issues and the use of HSE-salaried GPs. When completed this year, a report will be presented to the Minister for Health setting out the findings of the review and recommendations to address the issues examined.

We have heard in the course of this debate a number of very genuine concerns that exist across this House about the provision of GP healthcare services. The Government is fully cognisant of these and has been active in addressing them. We share the view that developing health service provision at the local level, within communities and as close to the home as possible, has many advantages for patients and for the health services. On this basis, the motion before us is not opposed.

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