Marie Sherlock (Dublin Central, Labour)

I move:

That leave be granted to introduce a Bill entitled an Act to make provision in relation to the availability of general practitioner medical and surgical services throughout the State, and to provide for related matters.

I am very proud to introduce my first Bill in the Dáil on behalf of the Labour Party. There is a reality that access to GP care is not equal across this country. It is a stark reality for the many people in my constituency and people in many parts of the country, for those born here and those who come to make their lives here, that they cannot even get on a GP list. There are then people who are on a GP list but cannot get an appointment for well beyond a week. The fact is that it depends on where you live. We have mapped out the GP to population ratio for most of the country, relying on 2025 data provided to us by the HSE and we have found extraordinary variation. There is one GP per 1,390 population in Clontarf in Dublin 3, yet in Cabra in Dublin 7, the ratio is one per 3,060 of population. Similarly, the ratio is one GP per more than 5,000 population in east Meath and one per just more than 1,700 population in south Louth.

Lower GP to population ratios have a very real impact for patients in terms of the time it takes to get an appointment and getting timely access to care. However, there is a double whammy here. Even more seriously, we know that GPs serving the most disadvantaged communities in Ireland encounter higher health needs among their patients. Yet, we have a lower ratio of GPs in deprived communities compared to more comfortable areas.

It is important to acknowledge measures have been taken by the Department of Health and the HSE in terms of additional GP training places, recruitment from South Africa and a number of other measures. They are all well and good but they are far from enough. The reality is we have a situation where the right hand does not really know what the left hand is doing because the Government is telling us they have increased GP training places, which is great, but no one is measuring how many of those GP graduates are going into the general medical services, GMS, scheme. At least, that is what the HSE tells us in responses to parliamentary questions. It is a point that has been powerfully made to me by Dr. Austin O'Carroll, when he felt he needed to establish a specific north inner city GP training programme to keep GPs there.

Our Bill is about ensuring the distribution of GPs across communities in this country is not left to chance. Our Bill effectively mandates the HSE to step in and take responsibility for ensuring GP services are distributed fairly across all parts of the country. That forward planning entails the HSE having regard to both the distribution of the population and number of GPs but, crucially, it is also about considering the actual levels of health need, based on social determinants in that specific area. What the HSE does with that information is another question. We have very clear views on that. The proposals on directly employing GPs have been around for years and yet we have seen no real progress in that space.

Even more important for us, we believe there needs to be fundamental changes to the GMS scheme. We also need to see tangible supports for GPs for setting practices, particularly in disadvantaged communities, and helping them with buildings and other supports. I have to be very clear here that while the State has been involved in building primary care centres over the previous number of years, what is not acceptable to me is that in those primary care centres, we have big GP companies like Centric becoming the anchor tenants in those primary care centres. I am aware of that in one part of this country. That was not the original intention of the primary care centres.

Our Bill is one part of the fundamental reform we need to see happen to ensure disadvantage is properly recognised in supports for GP care. The reality is that within the GMS scheme, GPs are paid according to a crude measure of the sex and age of their patient. No account is taken of the complexity of care need of their patient, social deprivation or other factors. It is a reality that in a GP practice in my own constituency, GP Care for All in Summerhill in Dublin 1, the average age of death is just short of 60. In most other parts of the country, the average age of death is well north of 80. That tells us much about the massive inequalities and the quality of health that exists across communities.

Last March, The Lancet medical journal devoted a whole editorial to the state of GP care in Ireland. It detailed how Ireland is an outlier with a private system of GP care, how its inaccessible primary care system places tremendous strain on hospitals and how this is a political choice. I hope we have the Minister of State's support when we bring this Bill further through the Dáil.

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