Joe Carey (Clare, Fine Gael)
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I thank the Ceann Comhairle for selecting this important Topical Issue. I compliment and acknowledge the work done by GPs throughout Ireland on a daily basis to look after their patients. They are a key part of the fabric of rural Ireland in particular. The existing general medical services, GMS, contract for public patients was first devised in 1972, and there has been little modification since then. There is a need to reinstate the financial supports available to rural GPs. Some 20 rural practices throughout Ireland are no longer in receipt of the rural practice allowance. There is also a need to restore the distance coding payment.

A total of 147 rural GP practices are in receipt of the rural practice allowance. It is a very restrictive payment. The payment is worth €16,200. In order to qualify for it, a practice must serve a population of fewer than 500 and be located at least 4.8 km away from an urban setting. The payment is tied to a GP, not to a particular area or practice. The withdrawal of the distance coding payment, which was given to rural GPs until 2010, is also undermining the viability of rural practices.

During recent weeks and months, I have worked very closely with Dr. Liam Glynn, a GP based in Ballyvaughan who took a High Court action against the HSE and was successful in having his rural practice allowance restored. I ask that the rural practice allowance be restored to the 20 rural practices that are no longer in receipt of it. I also request that the distance coding payment be reinstated. While I acknowledge that negotiations on a new GMS contract are under way, I ask that, as a gesture of goodwill, the payments be restored. There are two particular areas in County Clare, Feakle in east Clare and Kildysart in west Clare, that are no longer in receipt of the payment. There is a feeling in the GP community that they are aging and we need to make it more attractive for new GPs to come in and take up practices in rural Ireland. I am asking that these payments be reinstated, and I look forward to hearing the Minister of State's reply.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Joe Carey for raising this issue and providing me with an opportunity to update the House on the matter. 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 into the future. On 1 January 2016, 15 GMS lists, out of a national total of more than 2,400, were without a permanent GP, and five of these were in rural areas. However, the full range of GP services continues to be provided to the patients in these areas through either a locum GP or a neighbouring GP.

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. A key objective of the engagement with the IMO is to achieve revised and modernised contractual arrangements which support the sustainable delivery of enhanced GP services in local communities, especially in remote rural areas. As the Deputy pointed out, some 40 years have passed since the original contract was drawn up. 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 for the employment of staff, including practice nurses and secretarial support staff. The HSE recently produced revised rural practice allowance guidelines for remote rural areas. The purpose of the new guidelines is to ensure consistency, transparency and fairness in decision-making regarding rural GP practices and to provide additional options to support GPs. From time to time, HSE local offices offer other incentives, including access to HSE facilities, to attract GPs into rural areas. Such incentives may include offers of additional contracts, such as the contract to provide medical officer services to nursing homes.

I am aware that some isolated rural areas and deprived urban areas may find it difficult to attract GPs to fill vacant posts. I think this is what the Deputy is waiting for. I anticipate that the Department of Health and the HSE will shortly have a proposal to put to the IMO that will help to support and sustain rural practices. Although the existing rate of allowance for a single-handed GP is likely to be maintained, an enhanced allowance might be made available to GPs who are in group practice arrangements, for example, with GMS GPs outside the designated remote area but proximate to that area. In addition, we will propose special items of service to modernise the current arrangements and incentivise the provision of certain primary care services, such as new and emerging contraceptive methods. Having regard to the easing of the State's financial position, the Department of Health will shortly commence a formal consultation process under the FEMPI Acts in respect of the fees and allowances that are payable to contracted GPs. I emphasise that we feel we will shortly be in a position to make a proposal that - it is hoped - will find favour with the IMO in relation to rural practice and distance codes.

Joe Carey (Clare, Fine Gael)
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I thank the Minister of State for her reply. I agree with what she has said and I am heartened by it. Unfortunately, this issue has dragged on for far too long. I am asking today for the restoration of the payment of rural practice allowances that are tied down to 20 practices that are currently in operation, as well as the restoration of payments in respect of other practices that have fallen away because of the absence of rural practice allowances. I understand that a new proposal for rural general practice will have to be introduced and agreed as part of the negotiations on modernisation that are currently under way. As that will take time, I propose that the payment of these allowances be reinstated as a gesture of goodwill. They were taken away overnight, and I am asking for them to be restored overnight as well.

Kathleen Lynch (Cork North Central, Labour)
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While 20 practices may be more affected than others, there are more than 20 practices involved here. On that basis, this package will be offered to everyone in this category. The Deputy has suggested that something should be done "as a gesture of goodwill", but I believe what we are doing is something that will be sustainable into the future. I suggest that the Deputy should wait to see what the IMO's response to this proposal will be. I believe the package will help to incentivise GPs who already work in certain rural districts or certain deprived urban and rural areas, as well as those who might wish to take the opportunity to move to such areas. I ask the Deputy to wait to see what the IMO's response to this proposal will be. I hope it will be accepted by the IMO.