Mattie McGrath (Tipperary South, Independent)
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I am disappointed the Minister for Health is not in the House to take this Topical Issue. I know he is not abroad because he was in the House earlier today. While I welcome my colleague from Waterford, Deputy Coffey, this is not his area of responsibility.

On 25 September 2014, the National Association of General Practitioners, NAGP, took to the streets outside this House to protest over cutbacks that have closed rural GP practices and forced newly qualified GPs to go abroad to work. In the intervening period, nothing has changed. In fact, the situation is much worse. Rural GPs, who have already experienced a 40% cut to their income as a result of cuts to fees and allowances introduced under the Financial Emergency Measures in the Public Interest Act 2009, are still expected to operate without the guaranteed provision of a rural practice allowance and this is patently unfair.

The Minister of Health was urged in 2014 to redirect just 2% of the health budget to general practitioner services every year for the next three years to try to reintroduce parity of esteem for general practitioners. The NAGP has confirmed that up to 32 rural GP posts remain unfilled. Government policies are posing a serious threat to the health of people in rural areas and its unwillingness to fund the rural practice allowance has prevented doctors who would like to practice in rural areas from doing so. It was understood for decades by various Governments and the Department of Health that rural GPs need modest support structures in order to be able to function properly and remain viable and that is still true today.

In the case of Bansha, the incumbent, Dr. Madigan, is a wonderful doctor who has given sterling service, with her staff, the district nurses and health service staff. She has looked after the community very well. She is ill and has announced her intention to retire. I wish her well. However, we will not get a rural GP because people have been blindfolded and have their hands tied behind their backs.

The rural practice allowance is vital. There is no point in the Minister of State, Deputy Tom Hayes, coming to Bansha to reassure a public meeting that the Minister, Deputy Leo Varadkar, has promised to restore the general practice allowance in Bansha when there are 31 other posts to be filled, including in Clogheen in my own back yard, where a wonderful doctor, Dr. O'Reilly, who has been there 18 months cannot receive the allowance and is struggling to remain in place. When I had a parliamentary question answered by the Minister yesterday, he said it was a matter for the HSE. Someone is codding someone. Either the Minister is telling us fibs or the HSE is. The fact remains that Bansha general practice is in a serious position. Its GP is entitled to retire, but we are demanding that the post be readvertised and that the general practice allowance be included because it is needed.

I am told that there is a further complicating factor, although I do not have 100% proof of this, namely, that the HSE intends to charge rent for use of the health centre. This will make it completely untenable for any GP to use it. As a result, GPs are not applying for these posts. The GP in Gortnahoe wants to retire and a total of 32 doctors throughout the country are in this position, including in the Taoiseach's constituency of Mayo.

It is time the Government woke up to this problem. Pumping money into the so-called centres in Tipperary town and other areas where there are large practices is fine, but it is not fair to have people affected by the closure of rural practices, in particular, given that rural transport services are also being taken away. The regular transport service is not enough and people will be unable to get to Tipperary town, Cahir or Cashel. In addition, they currently have the comfort of knowing their GP and the staff in his or her practice, as well as the nurses, all of whom know the needs of their patients.

For many families the GP is the first line of defence, as the Minister of State knows. Whether it is a parent worried about a son or a daughter or a child worried about an elderly parent, the GP is the first person to be asked whether the patient is presenting with symptoms of, for example, Alzheimer's disease. The GP is the first line of defence and, in many cases, the only line of defence people living in rural Ireland have. We lost the post office in Bansha and have lost many other things throughout rural Ireland. We cannot and will not lose the general practice, too.

The Minister for Health should be here to answer this question. There is no point in there being a nod and a wink. The rural practice allowance must be restored in Bansha.

Paudie Coffey (Waterford, Fine Gael)
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I am taking this Topical Issue on behalf of the Minister for Health. I thank the Deputy for raising this important matter as it provides me with an opportunity to update the House on GP services. I acknowledge the contribution GPs and their staff have made both in urban and rural areas to the health and welfare of citizens. I assure the Deputy that the Government is strongly committed to the future of rural Ireland. Like him, I come from a rural constituency. We recognise the contribution rural communities have made to overall national economic development, as well as to the development of their local areas. Our vision is of vibrant, inclusive, economically thriving rural areas. The people living in these communities should experience a quality of life at least as high, if not better in several respects, as that experienced in urban areas.

The Government is committed to ensuring patients throughout the country will continue to have access to GP services, especially in remote rural areas, and that general practice will be sustainable in such areas into the future. The HSE, the Department of Health and the Irish Medical Organisation are engaged in a comprehensive review of the GMS and other publicly funded health sector GP contracts. Among the issues encompassed by the review process is support for general practice, especially in remote rural areas. I do not propose to comment on the detail of these ongoing negotiations. Under the current GMS contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual allowance of just over €16,200 and more favourable subsidies towards the employment of staff, including practice nurses and secretarial support. More advantageous supports towards locum costs for leave are also payable.

The HSE has recently produced revised rural practice allowance guidelines for remote rural areas. The purpose of the new guidance is to ensure consistency, transparency and fairness in decision-making regarding relevant discretionary provisions of the GMS contract as they apply to rural GP practices. The guidance also provides for greater flexibility in considering applications from GPs than that provided for in the original governing circular, as well as providing additional options to support GPs. From time to time HSE local offices also offer other incentives to attract GPs into rural areas such as access to HSE facilities and the offer of additional contracts such as providing medical officer services for nursing homes.

I am aware that some isolated rural areas and deprived urban areas, very often with limited private practice opportunities, may find it difficult to attract GPs to fill vacant posts. However, I have been assured by the HSE that where a GMS GP vacancy arises, the executive takes the necessary steps to ensure continuity of service to GMS patients is maintained.

Mattie McGrath (Tipperary South, Independent)
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I thank the Minister of State, but this is more waffle from the HSE. The plain fact is that too many cuts have taken place. I salute a young man in Bansha, Mr. Andrew O'Halloran, and his team for raising this issue, organising a public meeting and bringing their concerns, through me, to the floor of Dáil Éireann. The HSE states it will advertise posts and do everything it can to ensure continuity of service. It is like the farmer going to creamery without the bulk tank because he or she forgets to bring it. An appealing contract is what is needed. That is what we had for more than 40 years with the rural practice allowance, but it has been taken away with one swipe. To add insult to injury, rent is now being sought for use of the premises.

We are not going to get any qualified GP to come to a rural area in these circumstances. We are, therefore, shutting the door on rural Ireland. The Minister of State is a rural Deputy from my neighbouring constituency and should know this because it is plain and simple. Bansha was home to the late, great Canon Hayes who founded Muintir na Tíre. He always said it was better to light a candle than to curse the dark, but the Government is quenching the candle. It is extinguishing life in rural Ireland. It is taking sustenance from rural families, particularly the elderly and the vulnerable who want to meet their GP in their own area. People can walk or get a lift or a taxi to their local village. They do not want to be forced to travel ten or 12 miles to a doctor's surgery that is already full. A GP from Tipperary town said last week that he could not take any more patients because his practice was already overflowing.

It is a sad day when we allow the HSE to dictate to the Government and close down the rural practice in Bansha by stealth. It is making it uninviting or unappealing for any GP to work there because there is too much red tape and so little support. Shame on the Minister for allowing this to happen and shame on the Government for putting up the gates and quenching the lights in rural Ireland, especially in Bansha, which the late Canon Hayes ensured would be one of the first places to benefit from rural electrification in the 1950s. It is an insult to the people living there and the Government has done the same in many areas. Its view is to hell with the people. Cromwel said, "To hell or to Connacht." The Government is almost as bad. It is not good enough. I ask it to stand up to the HSE and ensure the rural practice allowance is reinstated. There are 32 communities which are affected, including Bansha.

Paudie Coffey (Waterford, Fine Gael)
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While I understand the concerns of the Deputy, I assure him the Government has no intention of closing GP practices.

Mattie McGrath (Tipperary South, Independent)
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It is happening.

Paudie Coffey (Waterford, Fine Gael)
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In fact, we have committed substantial resources and funding to ensure they will remain open and be supported as much as possible. The Deputy is concerned about the practice in Bansha, on which I will comment. However, there is a reason there is a vacancy there and it is not Government-created. It is, unfortunately, that its GP is on sick leave. That is the genuine reason there is a vacancy and the HSE informs us that it will be advertised. It will become vacant from 17 January 2016, according to the information I have received. The post is being covered by a locum, as I am sure the Deputy is aware, which means that all patients have access to GP services in Bansha.

It is important that is noted here because if one were to listen to the Deputy, one would swear the Government had closed the GP practice and disregarded the needs of the patients. That is not correct.

Mattie McGrath (Tipperary South, Independent)
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There are 32 vacancies.

Bernard Durkan (Kildare North, Fine Gael)
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One voice, please.

Paudie Coffey (Waterford, Fine Gael)
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With due respect, that is not correct. A locum is covering the practice and all patients have access to GP services. HSE South-East has advertised the post, but, unfortunately, there have been no applicants to date. However, the filling of the Bansha post is under consideration by the HSE. This consideration includes whether supports may be necessary in order to attract a suitable applicant to take on the post. For the information of the Deputy, there are no other GP vacancies in either south or north Tipperary and the next retirement in north Tipperary is not due until 2017. Therefore, the situation is not as bad as the Deputy has outlined. He is correct to raise concerns, but the HSE is responding and the service is being retained for the patients.

On 1 November, there were just 20 GMS lists, out of a national total of over 2,400, without a permanent GP in place. That is far from the accusation made by the Deputy in regard to the Government closing GP practices. That accusation is simply not true. Eight of the 20 vacancies are in rural areas with less than 1,500 people. However, the full range of GP services to patients continues to be provided for the patients concerned, through either a locum GP or a neighbouring GP. This will continue.

Mattie McGrath (Tipperary South, Independent)
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Codswallop. There are 32 vacancies.