Billy Kelleher (Cork North Central, Fianna Fail)
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1. To ask the Minister for Health to outline the measures that will be taken to put general practice on a sustainable basis, especially in rural areas; the progress that is being made on a new contract for general practitioners; and if he will make a statement on the matter. [43125/15]

Billy Kelleher (Cork North Central, Fianna Fail)
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What measures will be taken to put medical general practice on a sustainable basis, especially in rural areas? What progress has been made on the new contract for general practitioners? Will the Minister of State make a statement on the matter?

Kathleen Lynch (Cork North Central, Labour)
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The Government is committed to ensuring that patients throughout the country continue to have access to GP services, especially in remote rural areas, and that general practice is sustainable in such areas in future. It is imperative that services meet patient needs, that existing GP services are maintained and that general practice remains an attractive career option for newly-qualified GPs.

Under the current General Medical Services contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual rural practice allowance of a little over €16,200, subsidies towards the employment of certain practice staff at the maximum applicable rate, regardless of the size of the patient panel, and the maximum applicable contribution towards locum costs for periods of leave.

Where a GP holds the allowance but the circumstances underpinning it change, the GP retains the allowance while he or she continues to practise in that location. When a new GP commences in the area, the application for the allowance is considered afresh by the HSE.

The HSE has recently reviewed its guidelines for dealing with applications for a rural practice allowance.

The purpose of the new guidance is to ensure consistency, transparency and fairness in decision making in respect of the relevant discretionary provisions of the GMS contract pertaining to the granting or otherwise of the allowance to new applicants. The new guidance does not affect existing holders of the allowance.

The HSE, Department of Health and Irish Medical Organisation are engaged in a comprehensive review of the GMS and other publicly funded health sector contracts involving GPs. Among the many topics being considered under this review process is the issue of supports for general practice, especially in remote rural areas. I welcome the engagement which is taking place with a view to achieving revised and modernised contractual arrangements which support the sustainable delivery of enhanced general practitioner services in local communities.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am raising the issue because there is a crisis in rural GP services. Given the age profile of rural GPs and the regional imbalances in it, there is genuine concern that rural GP practices are not feasible or viable and that, as doctors retire, there will be no applications. Given the age profile, there will be a steady increase in the number of rural GPs retiring. If we do not have incentives or encouragement to sustain rural GP practices, we will have difficulty maintaining services in those areas.

Last week, there was a meeting in Bansha in south Tipperary. Dr. Marguerite Madden is retiring, and a large crowd turned out to highlight their concerns about attracting a GP to take over the practice. This is not the first time it has happened. We have had problems in Laois, Blarney in Cork a few years ago, and in Ballybunion more recently. If there were sustainability, viability and financial incentive, people would not refuse to take up these practices.

Kathleen Lynch (Cork North Central, Labour)
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It is one of the central issues under negotiation with the IMO. The figures are important. As of 1 November 2015, 20 GMS lists do not have a permanent GP in place, eight of which are in rural areas with populations of fewer than 1,500. However, each of the lists has either a locum GP or a neighbouring GP who has taken over the list and provides the full range of GP services to patients. Patients continue to have access to GP and primary care services. Permanent GPs are supplying over 99.9% of the GMS general practice services. This compares favourably with other countries, such as the UK, where the latest figures for 2013-14 showed a GP vacancy rate of 8% in the NHS. Of the GMS vacancies in Ireland, 50% of the 20 permanent vacancies are recent and have occurred during the past six months. It is a recent phenomenon and has more effect on urban areas of deprivation than in rural areas. Sometimes, we miss this point.

Billy Kelleher (Cork North Central, Fianna Fail)
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While I highlighted the age profile of the GPs, the age profile and demographics of the remote and isolated areas where there is rural decline also show that there is a higher proportion of older people there. Given the principle of primary care, treating a person suffering from chronic illness or minor procedures in the least complex environment, the need is obviously to retain GPs in rural areas to provide primary care. This would be complementary to other primary care and community-based services. The fact that these areas have low populations does not mean there is not a high dependency on rural GP practices and primary care, particularly when one considers the demographics of these rural areas and the regional disparities between urban and rural areas but, more importantly, in the isolated areas.

Kathleen Lynch (Cork North Central, Labour)
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Again, the GP vacancy rate in England is 8% compared to 1% here. The population across the country is aging. There are exceptional circumstances in rural areas and this is why we have additional allowances and give additional leave allowances regarding employment of staff and locums. Although a substantial grant is available, it is not just about money, as we know. Maybe, people do not want to develop their careers in that type of isolation. Maybe they want to be in urban areas. This is why we need to make it more attractive. This is central to what we are doing regarding the IMO.