Timmy Dooley (Clare, Fianna Fail)
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I welcome the Minister of State at the Department of Health and Children, Deputy John Moloney, to the House to give details of the Government's recent announcement to increase the number of general practitioner, GP, places in the medical school system, a long overdue decision. It is a correct decision to increase the level of training for GPs when finances are available at the earliest opportunity. It is also important when one considers the home and community-orientated direction international best practice has taken in the delivery of primary medical care to patients. With the advances in, for example, keyhole surgery and other medical practices, people tend to spend less time in hospital and more time recovering at home.

The precursor to all of this is the necessity for a much more enhanced level of primary care. The GP, therefore, is the medical person best positioned to decide on the care of any particular patient. The practice, heretofore, where GPs were under high levels of stress and pressure, was to refer patients to a hospital environment for further investigation or treatment. International best practice indicates this is not best way. There is a need for much more of the work to be done in the community to ensure the best outcome for the patient.

The Government aims to increase primary care centres in the environs of doctors' surgeries, at which more diagnostics can be done in the community. It follows there will be a requirement for a greater number of GPs. It is welcome that the Government will increase the number of GPs. It recognises the greater degree of interest from GPs to perform much more of this work in their communities as they wish to develop primary care centres

It is interesting that the Finance Bill has been passed because, while not relevant to this discussion, there is a desire among groups of general practitioners for favourable taxation measures to ensure the development of these centres. They will not happen on their own or out of the blue. There is a requirement to assist doctors and investors to ensure the facilities are built and the necessary equipment is provided so these procedures can be carried out in the community. In welcoming the Government proposal to increase the participation of students at training level, I ask the Minister of State to outline the proposals to ensure an even spread of GPs throughout the country. As places become available, they should not be concentrated only in large centres of population. It is important that rural areas get a fair crack of the whip.

I give credit to the difficult work GPs do in the community in attempting to work within the change in policy of having more work done in the community. I pay tribute to the efforts GPs are making and the pressure they are under to deliver that. We owe a tremendous debt of gratitude for those who managed to deal with the reconfiguration programme in the system. They continue to provide an exemplary and exceptional service to the communities. The provision of extra places and extra GPs will help to lift the considerable burden many GPs are under.

John Moloney (Laois-Offaly, Fianna Fail)
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I apologise that Minister for Health and Children cannot attend. There are about 2,600 full and part-time GPs in active practice in the State and some 300 doctors working in a locum capacity. Of these, about 2,100 GPs are contracted by the HSE under the GMS scheme to provide services to medical card and GP visit card patients.

The ESRI published a report entitled General Practitioner Care in October 2009. It found that Ireland has a low ratio of GPs to population compared to other western European nations, with 56 GPs per 100,000 of the population. In contrast, France, Austria and Germany have more than 100 GPs per 100,000. The increasing age profile of GPs means the ratio of GPs to population is decreasing. At the same time, demand for GP care is increasing due to demographic change. The report predicted total GP consultations will increase by 20% by 2015 and by 33% by 2021. The ESRI stated that if GP training numbers were increased to 150 per annum, this would make a substantial impact on the shortfall.

There is currently one model of GP training in Ireland, which is provided by the Irish College of General Practitioners, ICGP. It is a four year model, with two years based in hospital and two years on an approved GP training programme. There are currently 12 GP training programmes with 120 training places available per year. A report on primary medical care in the community by the Joint Committee on Health and Children published on 10 February included a recommendation that there be an immediate expansion of GP training places to a minimum of 150.

The HSE and the ICGP have agreed to increase the number of GP training places to 157 from 1 July. The expansion of GP training places is a significant initiative and demonstrates the commitment of Government to the pivotal role of general practice in the Irish health service. It will support the continued development of primary and community care services, facilitate the delivery of care to patients in their own communities and reduce the need for unnecessary hospital admission. The increase in GP training places has been brought to fruition by a partnership approach between the HSE and the ICGP. The Royal College of Physicians of Ireland has also been extremely supportive. The work of GP training programme directors and the engagement of consultant clinicians on a number of hospital sites have also been critical success factors. It is also pleasing to note that this expansion has been achieved from a more effective use of existing resources and without the need for any extra funding. The HSE, with the support of the Department of Health and Children, is pursuing a number of initiatives to increase the number of GPs working in the health service.

It has held discussions with the ICGP to identify a mechanism to upskill long-term locums or assistants who have not passed the requisite examination or obtained an award of the certificate of satisfactory completion of training from the Medical Council. It is estimated that up to 250 doctors are involved. A recruitment drive has been undertaken in the UK and in other EU countries to attract qualified GPs to apply for available posts here, particularly in regions experiencing difficulties attracting GPs. There is also more active management in each local health office to encourage GP assistantships and partnership for upcoming retirement where such doctors could potentially take over from GPs retiring. The HSE is continuing to expand primary care teams and primary care centres so that GPs are attracted to high quality, well-supported posts in suitable premises.