Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the office of the Ceann Comhairle for allowing me to raise this important matter on the Adjournment. I appreciate that the Minister of State, Deputy Shortall, is here to reply.

For many decades there was a GP service in Ballinagh, County Cavan, where I understand from local residents a quality GP service was always delivered. In recent years the service was provided by Dr. Prior and his colleagues. The local community very much appreciated his work, as well as the dedication and commitment of the practice. Unfortunately, a number of weeks ago the GP service provided from the health centre ceased temporarily.

The absence of a GP service which was provided four days a week is a source of major concern. About two weeks ago the local community organised a public meeting. The main organiser was Mrs. Brigid Delaney, whom I compliment on organising the meeting which attracted a large attendance which included public representatives such as me. The meeting was well structured and gave members of the community an opportunity to outline their concerns about the delay in having a GP service restored to the health centre. A number of years ago Mr. Cian Murtagh established a successful pharmacy in the town. The local community appreciates the excellent service provided in what is a relatively small town but which, however, has a wide rural catchment area. We all realise a GP practice in close proximity to a pharmacy can play a vital role in ensuring the long-term viability of that pharmacy business.

Some time ago a county councillor for the area, Councillor Charlie Fleming, highlighted to me and Senator Diarmuid Wilson the inadequacy of the old clinic premises on Crosstoney Road. Senator Wilson and I successfully lobbied the HSE and the then Minister for Health and Children to agree to the provision of a new health centre in the town. There was a major investment of €1.3 million in a state-of-the-art health centre. I had the privilege of performing the official opening in February 2008. That investment was widely welcomed and supported by the local community as it provided for new facilities for the GP practice, as well as nursing care and other health services.

It is a source of serious disappointment to the local community that the GP service has ceased temporarily. In correspondence to me, locals have said they are anxious that the GP service be restored without delay. I have received numerous letters and telephone calls from many senior citizens who are concerned that the temporary cessation of the GP service could ultimately lead to its long-term loss. That will not be tolerated by the local community in Ballinagh. Therefore, I urge the Minister of State, through her Department and the HSE, to insist that the GP service be restored without delay.

Local people expressed their genuine concerns at the recent public meeting and it was noticeable that concern was being expressed by senior members of the local community who had to avail of GP services on a regular basis. They need to travel to the health centre regularly. Many of the people who spoke at the meeting do not have cars and if required to travel four or five miles to an alternative centre will be dependant on family, friends or taxis to do so, which is not feasible in the long run. Also prominent at the meeting were the parents of many young children who, as we all know, often have to attend a general practitioner. They forcefully advocated that this service needs to be restored without delay. If the service is not restored imminently, people will have to travel a number of miles to Cavan town, Kilnaleck or Killeshandra to practices that area already under pressure. All of us in this House support the provision of more services in the community. In my county, we have been fortunate to have had in recent years an excellent primary care centre in Virginia alongside a nursing unit. The situation is similar in Ballyconnell and others are being developed throughout the county.

These new state-of-the-art facilities must be used to the maximum. I appeal to the Minister of State, Deputy Shortall, to ensure, through the HSE, that the general practitioner practice is resumed in Ballinagh without delay. In this regard, I am conveying the strong wishes of the local community.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Smith for raising this issue. The general practice at Ballinagh health centre has a substantial number of General Medical Services, GMS, clients. Currently, there is only one GMS general practitioner within the practice as one resigned recently on health grounds and another has been on long-term leave. The suspension of general practitioner services in Ballinagh health centre is a short-term measure pending the sourcing of the services of a locum. There are almost 2,300 general practitioners contracted by the HSE to provide general practitioner services under the GMS scheme to more than 1.6 million medical card holders and 120,000 general practitioner visit card holders.

The EU-IMF programme provides for the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors by the end of the third quarter in 2011. This includes eliminating restrictions on general practitioners wishing to treat public patients. The Deputy will be aware the current system has been in place for some time. It is a system whereby access to the GMS is only available to new general practitioners if an existing general practitioner retires or dies. The intention is that will change, namely, that the HSE will be in a position to take a much more proactive role in terms of ensuring adequate coverage of general practitioners in the country. Unfortunately, under current arrangements, that is not possible. However, we are moving towards a new situation.

The Government recently agreed to the preparation of heads of a Bill which will eliminate current restrictions on fully qualified and trained general practitioners wishing to obtain contracts to treat public patients under the GMS contract and empower the Minister for Health to set entry terms based on public health interest considerations. This proposed legislation will result in medical card and general practitioner visit card patients having a greater choice of general practitioners under the GMS scheme. It will also help to ensure private patients of new general practitioner contract holders, who qualify for a medical card or general practitioner visit card, will not have to change their general practitioner.

The Government is committed to establishing a strong system of primary care in Ireland. My appointment as the dedicated Minister of State for primary care is a clear indication of the Government's intentions in this regard. The development of primary care teams and primary care centres is a priority under the programme for Government. This will significantly increase health and social care in local communities, which will be achieved by redirecting services away from acute hospitals. Modern, well-equipped primary care centres will be central to the effective functioning of primary care teams. The centres will allow multidisciplinary services, provided by general practitioners, nurses, physiotherapists, occupational therapists and others, to be made available on a single site, providing a single point of access for the user and will encourage closer co-ordination between providers. The new centres will greatly assist in the provision of modern services, in particular the provision of chronic disease management by multidisciplinary teams.

I look forward to the developments that will take place later on this year, when access to the GMS will be opened up for general practitioners generally. I thank the Deputy for raising this issue.

Gerry Adams (Louth, Sinn Fein)
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Tá mé fíor bhuíoch díot, a Cheann Comhairle, as seans a thabhairt dom labhairt ar an ábhar tábhachtach seo. Beidh mé ag caint faoi dhruganna agus daoine bochta atá faoi bhrú ag druganna.

Several weeks ago, Councillor Paddy McQuillan and I visited the Louth community drug and alcohol team in Drogheda. We met the staff, members of the north-east regional drugs task force and a group of addicts who are on methadone to control their heroin addiction. I was impressed by the commitment and professionalism of the staff who provide a first class service with limited resources and who are struggling to meet the needs of a growing number of drug and alcohol addicts. I commend and thank them for their work.

Drug and alcohol misuse has taken up to eight lives in the Drogheda area in recent years. The former heroin users whom I met were young men and one young woman. They were honest about the dreadful impact the drug has had on them and their families and the connection between heroin and drug addiction and crime. One former user described the experience as being like groundhog day, chasing the money, chasing the dealers and chasing the drug. When that cycle is complete, they begin the process all over again.

The drug and alcohol team in Drogheda has only been in place since last April. I have no doubt from my conversation with the former heroin users that the centre has been a lifeline for them. The project consists of one co-ordinator, one project worker, one community employment support staff member and one counsellor who provides six sessions a week. According to statistics for 2010 from the Health Research Board, 76 individuals presented for treatment at the centre. Of these 60% suffered heroin addiction, 28% had issues with alcohol, 17% with cannabis and 7% with cocaine. Some 71% of the above have been identified as early school leavers and 60% use more than one drug. Some 33% are injecting drug users and 8% began injecting under the age of 19 years.

There are obviously policing and other issues around the availability of illegal drugs. These statistics only scratch the surface of the problem. We will return to that another day. The reality is that many individuals who initially presented with one problem actually have more than one. Some are addicted to up to four substances. Those with whom I spoke told of many more users in the area who have not sought help.

The Louth community drug and alcohol team work hard to provide a service which helps those affected by drug and alcohol misuse. The biggest gap in current services lies in the absence of a second level 2 methadone prescribing general practitioner. There is only one methadone prescribing general practitioner and, consequently, the waiting list for methadone treatment in Louth stands at 18 months compared with ten days in Dublin, which discourages individuals going on the list. Even if an addict manages to get on the list, he or she is expected - this is the way the system works - to maintain his or her drug using lifestyle to qualify for treatment. This means that the current system is encouraging ongoing heartache, illness, further family breakdown, crime and, in some cases, overdose which can lead to death or suicide.

I urge the Minister to appoint a second level 2 methadone prescribing general practitioner quickly. This would have an immediate and beneficial affect on the management of heroin treatment in Louth. The community drug and alcohol team also needs a dedicated project worker who can provide the essential family support that is part of dealing with drug misuse in the community. The problem of heroin misuse is severe and requires urgent attention and additional financial support. I urge the Minister to take these simple measures and enhance the work of a dedicated group of professional health workers who are making a significant contribution to society and to assist those recovering addicts who are confronting their problems and need help to put them behind them.

Róisín Shortall (Dublin North West, Labour)
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I thank the Deputy for raising the issue. The HSE provides methadone as an opiate replacement to support those who are addressing their heroin misuse problem. Methadone is a controlled drug regulated under the Misuse of Drugs Regulations 1998. Only GPs who are trained as level 1 or level 2 for methadone prescribing are permitted to participate. The HSE, through the Irish College of General Practitioners, facilitates GPs to train at level 1 and 2. Level 1 GPs can provide methadone in a community-based setting to stabilised patients who do not require methadone clinic services. The HSE encourages all GPs to take part in this training. Level 2 GPs are trained to offer the full range of treatment services to opium dependent patients including assessment, initiation of treatment when appropriate and stabilising a drug user.

Persons receiving methadone treatment are registered on the central treatment list, operated by the Drug Treatment Centre Board. At end April 2011, the central treatment list recorded 9,289 patients attending treatment in clinical facilities within the HSE Dublin north east region. There has been a focus over the past year or two on increasing the availability of drug treatment services outside Dublin. Significant progress is now being made by the HSE. Additional services have been provided in the south east at Wexford town, Waterford and Kilkenny, in the southern area at Cork and Tralee, in the mid-west at Limerick city and in the north east at Dundalk. The HSE is progressing plans to provide methadone facilities in the midlands, Drogheda and Wexford county to address waiting lists and times in these areas.

Approximately two-thirds of those in receipt of methadone continue to receive their service in clinics, with the remainder under the care of GPs. I would like to see an increasing transfer of clients from clinics to GPs in coming years, subject to the agreement of the service users and adherence to good clinical practice. The acquisition of GPs for the methadone treatment programme is not an easy task. The HSE has advised that it has identified two potential level 2 GPs who are available to commence in the Drogheda area. An additional level 1 GP has also been identified and the HSE is awaiting return of a signed contract from the person concerned.

The Louth Community Drug and Alcohol Team is funded by the Department of Health through the north east regional drugs taskforce. The taskforce has allocated just over €116,000 in 2011 to the Louth Community Drug and Alcohol Team. This funding enables it to employ two members of staff. Both staff members are actively involved in one-to-one work with individuals with an alcohol and-or substance use issue, and this also includes working with family members and concerned persons. Louth Community Drug and Alcohol Team provides services and supports for people in active addiction, particularly those who are hoping to stabilise, reduce or become totally drug or alcohol free. Working from a harm reduction perspective through individual supports and group programmes the service also supports the delivery of a needle exchange service in Drogheda. It also strives to provide families with adequate information and support on addiction related issues, including the provision of information to the wider community. The two full-time staff work alongside sessional counsellors, trainees, volunteers and placement students to provide a low-threshold tier 2 or 3 service. Unfortunately, there is no funding available to support an additional family support worker. I again thank the Deputy for raising the matter.