Seán Fleming (Laois-Offaly, Fianna Fail)
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I wish to raise the issue of the need for the HSE to appoint a new GP to fill the vacant position in Borris-in-Ossory in County Laois. I appreciate that the Minister is here in person. The background to this situation is very straightforward. It is happening in many areas in rural Ireland, in particular. The doctor who has been there for many years, Dr. Fitzgerald, is retiring. I thank him and his patients will thank him. He is entitled to retire and we wish him well. A question has now arisen regarding replacing him. The HSE advertised the position and conducted interviews. Two people applied for the position, but the financial package that was available was not sufficient to allow a doctor to move into the area.

Historically, when a GP who held a GMS medical card contract lived and practised in a centre of population with fewer than 1,500 people and there was no town with a population of more than 1,500 people within three miles of it, the GP was entitled to a rural practice allowance. The figure for the rural practice allowance is about €16,216. I understand the position in Borris-in-Ossory was advertised without this allowance. The town of Borris-in-Ossory meets the population requirement. Further, there is no town within a three-mile radius of it with a population of more than 1,500 people. We are talking about serving an area which includes Borris-in-Ossory and surrounding areas such as Ballybrophy, Killasmeestia, Pike of Rush Hall, Ballaghmore and Camross. Essentially, from the Minister's perspective, this is a town on the road between Mountrath and Roscrea on the old N7 road. The town was bypassed recently by the motorway.

A very strict interpretation of the rules is being applied by the HSE. One issue is that it is saying that the GP must live in the area. Historically, sometimes a house came with a practice. This is not the case here and no one thinks a GP should be offered a house in this day and age. If a GP is getting a practice, like everyone else he or she will have to provide his or her own house. However, the HSE seems to be saying that because the person will not be living and practising in the area, he or she will not be eligible for the rural practice allowance. I am asking the HSE, through the Minister's office, to go back to the people who applied in the first place and to offer them the rural practice allowance. This will make the position financially viable. The rural practice allowance allows a GP to have funding to support a practice nurse, secretary and, if necessary, manager. This cannot be done without an extra allowance. The GP cannot pay for this out of his own salary.

This leads to a bigger issue. GPs in many practices throughout the country have been telling me that they would love to be employed as a doctor, that is, to do the business they are trained to do. However, they have to run the local health centre and look after various other matters such as the costs of administering the centre, IT facilities, human relations issues and the practice nurse and other staff that come and go through a health centre. It is a management position in its own right. All of this is taking up GP's time which should be spent on patient care. The rural practice allowance should be allowed in this case.

Last Sunday, the local parish priest raised this issue at mass. He asked local politicians to speak up for the area because he felt some of the small areas no longer had a voice. I am asking the Minister, therefore, to ensure that the position of the GP will be filled in Borris-in-Ossory and if this means giving the rural practice allowance, I ask the Minister to do that.

Leo Varadkar (Dublin West, Fine Gael)
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The HSE is committed to the provision of high quality GP services through the GMS GP contract. GMS GP posts are filled in line with the HSE's human resources recruitment guidelines. Periodically, challenges can be experienced in regard to the permanent filling of GP posts. In areas where this challenge is experienced, every effort is made by local HSE management to ensure the provision of GP services to all GMS patients.

The retiring doctor in Borris-in-Ossory advised the HSE of his intention to resign from the GMS scheme in November 2014. The GP's practice is a single-handed, rural practice with a GMS panel size of approximately 830 patients. The GMS panel was advertised by open competition and interviews took place in late 2014. Two applicants applied and both were placed on a panel following successful interview. Both candidates subsequently declined the offer of the position. The position was subsequently re-advertised by open competition, in early February 2015, and interviews are scheduled for 4 March 2015. The retiring doctor has agreed to continue in post at least until after the March interview and the conclusion of the selection process, allowing time for the post to be filled. We are very grateful to him for that.

While GP numbers are keeping pace with overall demographic trends, this does not always prevent shortages at local level. GPs, once qualified, tend to work for existing GP practices or as self-employed contractors, and are free to decide where to establish their practices. Isolated rural areas and deprived urban areas, very often with limited private practice opportunities, may sometimes find it difficult to attract GPs to fill vacant posts. The HSE is seeking to address this issue at present with the medical organisations with a view to developing practical measures. This includes reorganising lists with existing doctors in local areas and adopting more flexible contractual arrangements which would encourage young GPs to work in such areas.

The Department and the HSE are currently in discussions with the Irish Medical Organisation, IMO, about the introduction of flexible or shared GMS contracts. The possibility of extending the GP retirement age from 70 to 72 years is also being considered. The introduction of flexible or shared GMS contracts would provide more family-friendly working arrangements better suited to younger GPs who have young families, thus making it more attractive to pursue working in the GMS scheme.

Under the programme for Government, it is intended to develop a new contractual framework for GPs which will be more suited to current needs and will facilitate the planned development of primary care services. Substantive discussions on a new GMS contract for GPs will commence shortly with the IMO.

Mechanisms for encouraging GPs to set up practices in rural and urban disadvantaged areas will be considered, as appropriate, in the context of these discussions. In the meantime, where GMS GP vacancies arise in an area, the HSE will take the necessary steps to ensure that continuity of service to GMS patients is maintained.

Seán Fleming (Laois-Offaly, Fianna Fail)
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I thank the Minister for bringing us up to date on the recruitment process. The Minister said there had been an earlier competition and that both candidates had declined the offer of the post. They declined it because of the financial package on offer, which excluded the rural practice allowance. If the HSE is re-advertising, which has happened, and interviews are to be conducted in the coming weeks, the Minister should ensure that the rural practice allowance is brought back to the table. I understand that management in the HSE at local level appreciates the need for this and has requested HSE approval at national level. This has been declined. This is essentially why we have to go through the advertising process again.

The Minister actually copperfastened the fears of the local community in his reply when he said he was examining various options including the reorganisation of lists with existing doctors in local areas. Essentially, if he goes down that route, which is what everyone is concerned about, some patients in the Borris-on-Ossory catchment area will be told to go to Roscrea and the rest will be told to go to Rathdowney or Mouthrath. That is the fear of the local community. The Minister wants to disperse the facilities that are already in place. There has been a big investment in the health centre over recent years and it would be a shame not to continue to have a doctor there. We know a single-doctor practice can only provide a limited amount of hours, but what will happen is that once the new recruit, be it a lady or a male doctor, is part of the MIDDOC system, there will be out-of-hours coverage for people in the relevant areas. To talk about reorganising the lists and sending some people miles further from where they traditionally got their service is not the answer.

My final plea to the Minister, on behalf of the people of Borris-on-Ossory, is to commit to reinstating the rural practice allowance. He has just said it can be financially difficult to attract people to the area. Doctors are entitled to earn a reasonable living, and this allowance is essential in that regard. It is essential that it be part of the package.

Leo Varadkar (Dublin West, Fine Gael)
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There is a panel of 830 patients. Unfortunately, this is relatively small from the point of view of a GP. Unless it is heavily supplemented by private patients and private incomes, it can be hard to operate a practice on that basis. The panel may be small from the point of view of an applicant GP. The service is, of course, very important to the community itself.

The rural practice allowance has rules applying to it. There are also contracts agreed with the IMO. It is not open to me to change the rules or bend them on an ad hocbasis for the benefit of any individual GP or community. When trying to fill a rural list, which is a difficulty in some parts of the country, we are up against the fact that an increasing number of GPs do not want to work in single-handed practices. They want to work in groups, as part of multidisciplinary teams and in primary care centres, because that is what they were trained to do. That is why this will be an ongoing problem. Even if allowances were higher and there were additional financial incentives, young GPs coming through the training system would want to work in group practices with sub-specialties and so on. This presents a difficulty.

With regard to the options, they always include the possibility of bringing in a locum and re-advertising the position, if needs be. Dividing the list would only be done as a last resort. I agree that it would not be desirable. I certainly hope the interviews on 4 March will be successful.