Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Question 28: To ask the Minister for Health and Children the measures she will undertake to address the general shortage and uneven distribution of general practitioners, particularly in the Dublin region; and if she will make a statement on the matter. [26287/09]

Róisín Shortall (Dublin North West, Labour)
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Question 79: To ask the Minister for Health and Children her views on the report of the Expert Working Group on Future Skills Needs carried out for her and the Health Service Executive which found that there will be a need for more than 100 additional general practitioners annually to meet the needs of the population and to address changing work practices and gender distribution; if the number of general practitioner training places will be increased to address this need; and if she will make a statement on the matter. [26336/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 28 and 79 together.

I welcome the recently published report by the Expert Group on Future Skills Needs which includes workforce planning analysis for selected health care occupations, including general practitioners. Among its findings, the report indicates that the current gender distribution in general practice will be reversed in the future with a ratio of 65 females to 35 males. It also predicts that by 2020, almost 30% of female and 5% of male general practitioners can be expected to work part-time. There are 12 general practitioner specialist training programmes currently in operation in the State. They are all of four years duration - two years spent in hospital posts under the supervision of hospital consultants and two years in an approved general practice under the supervision of a general practice trainer. The total number of places available is 120. The report predicts that this figure will not be sufficient to meet the demands of a growing and ageing population into the future.

The Health Service Executive and the Irish College of General Practitioners are currently in discussion with a view to increasing the number of general practitioner trainees by streamlining existing programmes in a cost-effective manner. In addition, the college has identified a number of doctors who have not had formal training in general practice but who are interested in pursuing a career as a general practitioner. The provision of a programme of training for these doctors is also being examined.

The Health Service Executive is also taking steps to increase the number of general practitioners who can take on patients with medical cards. A rule which allowed doctors who currently have patients who hold general practitioner visit cards to also take on medical card patients after five years has been amended to allow such doctors to take them on with immediate effect. Nationally, there are in excess of 50 doctors in this category, 20 of whom are in practice in the Dublin area.

Recruitment of general practitioners to provide services under the GMS scheme has been made simpler with a list of posts being advertised centrally on the HSE website. Proactive management of upcoming retirements by local health offices is in place to flag potential general practitioner vacancies at an early stage. Articles have also been placed in UK medical magazines highlighting general practitioner opportunities in Ireland.

It has been my intention for some time that any restrictive rules preventing fully qualified general practitioners taking on patients under the GMS scheme should be ended. In that context, a consultation group involving my Department, the HSE and the Irish Medical Organisation has been reviewing the provisions relating to entry to the GMS scheme. I understand that considerable progress has been made and that detailed recommendations from this group will be presented to me shortly, with the objective of increasing the pool of general practitioners who can take on medical card patients.

My Department will discuss the contents of the expert group report with the HSE and other appropriate agencies in the coming months to ensure we continue to have an adequate supply of general practitioners available.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Minister for her reply. Does she accept that the ratio in this State of 0.6 GPs to every 1,000 of the population is a major problem? This ratio compares to an EU average of one GP to every 1,000 of the population. This ratio falls even further in more disadvantaged areas such as north Dublin where its stands at one GP to every 2,500 of the population. This issue was also recently raised at Carrickmacross Town Council where a Government party councillor highlighted the fact that some locals had been forced to travel as far away as Dundalk to attend a GP. A 2007 study found that one in every four of paying patients in the 26 counties who had a health problem did not attend a GP because of the issue of affordability. That is another alarming fact that must be taken on board.

Brendan Howlin (Wexford, Labour)
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Does the Deputy have a question?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am concluding with this point. The shortage of GPs restricts the time a GP has to engage with a patient and the opportunity he or she has for health promotion. While acknowledging some steps have been taken as the Minister's reply indicated, what further steps are proposed? Will the Minister agree it is alarming the HSE has had to recruit GPs outside of Ireland to meet the current shortfall?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Ó Caoláin is correct that Ireland has a lower GP-population ratio of 58 GPs to 100,000 people when it is 67 to 100,000 in Northern Ireland and the UK, a difference of nine. Notwithstanding that, we also have restrictive work practices with up to 400 doctors not being allowed access to the GMS lists because of an industrial relations agreement. While we want to provide practice supports to practices with relatively large numbers of patients - otherwise it would not be cost effective - I do not believe it is sustainable or fair to those general practitioners. The 50 doctors on the doctor-only medical card will be allowed to have access to the full GMS list. That will increase the number of GPs in the Dublin area, where there are particular shortages, by 20.

Since 2004, the number of training places has been significantly increased from 84 to 120. A number of doctors who work in general practice have not done the GP-training programme. I have encountered several of these cases where they were working with a general practitioner for years but when he or she retired they were not qualified to take over the practice. It is a sore point and I understand the colleges are examining the possibility of a training programme for doctors affected to increase supply.

The main challenge with changes in gender distribution, family and lifestyle commitments and so on is to ensure the numbers in general practice increase. It is essential for the move from hospital to community care to place more emphasis on general practice.

Jan O'Sullivan (Limerick East, Labour)
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All Members will agree having an adequate number of GPs is crucial in treating more people in a primary care and community system rather than an acute hospital one. The Minister stated in her reply the current graduate supply is 120 GPs per year and hoped to increase that figure by "streamlining existing programmes in a cost effective manner". Will the Minister decode this HSE-speak? Does it mean training more GPs for the same amount of money?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The number of trainees has increased from 84 to 120 since 2005, a significant increase. Discussions are under way between the Health Service Executive, the Irish College of General Practitioners, the Irish Medical Organisation and the Department on many of these issues and they will report to me presently. While I do not like using the word "innovative" in an inappropriate way, we need to be innovative, particularly with those doctors already working in general practice who have not done the original GP-training programme. We need to provide an opportunity for them to qualify for a GMS list. It is unfair they are already dealing with all other patients, including GMS patients, but they cannot take over the GMS list.

James Reilly (Dublin North, Fine Gael)
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I welcome the Minister's acknowledgement of doctors working in general practice who have not completed training but are quite experienced. It would be laughable for them to have to undergo full training. We must, however, be careful about maintaining the quality of general practice. I also welcome that those doctor-only visit card doctors will be now able to take on all GMS patients. When was the rule amended?

The Minister must acknowledge there is an increased need for training. While the number of trainee GPs has increased to 120 since 2005, with changing demographics and working practices the whole-time equivalents of those currently qualifying will actually turn out lower. While the Irish College of General Practitioners sought 150 graduates a year, up to 200 are needed. What plans has the Minister got to address this matter? The HSE has also been suppressing this by allowing doctors to amalgamate lists when the doctors' organisations opposed it. I certainly oppose it, wanting more, not fewer, doctors in the community.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The restriction on access to the GMS scheme was an agreement with the Irish Medical Organisation, representing general practitioners a long time ago. I have had many young doctors ask me why they cannot have access to the GMS scheme. I put a group together to examine this and it will report to me shortly. I see no justification for restricting access to GMS to any doctor.

I acknowledge that for supports such as practice nurses to succeed, critical mass is needed. France has 164 general practitioners for every 100,000 people. Last year I met a group of French general practitioners. Before Deputy Reilly gets a fright, I am not advocating their pay rates. However, I learned they earn €60,000 a year; they were amazed at how much our doctors earn. They get no practice supports whatever, do an incredible amount of work and greatly alleviate pressures on the acute hospital system. I am all for increasing the number of general practitioners. As we are doubling the number of medical students, I would hope we will be able to retain as many of them as graduates in medicine, particularly in general practice.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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How many of the trainees are being retained in Ireland and how many leave the country? I am concerned with the aging population of doctors in the north east and the need for their replacements. With the new services proposed by the Minister, their replacement will be necessary.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I am glad the Minister used the French example. The figures she cited for the North of Ireland and Britain do not reflect the EU average, which stands at one GP per 1,000 people. I would like to ask the Minister about access to medical education. Places are critical in terms of the number of general practitioners we turn out. We also need to examine the issues of affordability. Access to medical training continues to be affected by elitism. I do not mean any disrespect when I use that word. Very few families can afford to pay for the many years of training a young person needs to become a doctor. The course that is followed during the period of training is quite intense. We need to bear in mind that fine young people from many families across this country who could become excellent general practitioners are not able to access what they see as their natural calling as a consequence of the exorbitant and prohibitive costs involved. I would like that aspect of the matter to be addressed so that we can achieve equality of access.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I spoke earlier about the number of locums working in general practice. I understand that the Irish College of General Practitioners, in conjunction with the HSE, recently published an advertisement seeking expressions of interest from practitioners who would like to qualify to be on the specialist register. The Irish Medical Council requires doctors to be on the specialist register in order to work as general practitioners. I understand that 219 people have responded to the advertisement, which is very satisfactory. If the number of general practitioner training places, which is approximately 120 at present, can be increased by a further 219, that would be very welcome indeed. I accept that the people in question are currently working in general practice. However, they are not in a position to hold general practice registration with the Irish Medical Council.