Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for taking this important Topical Issue, namely, the need for a dedicated general practitioner, GP, training programme for County Kildare. We have a great GP service, but I am concerned about the amount of pressure on the county's current GPs. It will only worsen as the county's population grows and older GPs move towards retirement.

Someone who wants to become a GP studies medicine for six years, does a one-year internship and spends four years in the training programme for dedicated GPs, which entails two years in a hospital and two in practice.

There is no clearly defined area for Kildare at present. This creates a problem for retention levels. The latest Medical Council workforce intelligence report shows that County Kildare has only 41 GPs per 100,000 population. This is the fifth lowest ratio in the country and is well below the national and international averages, the national average being 51 per 100,000. Up to 25% of Kildare GPs are predicted to retire in the coming decade. This is concerning and, if they are not replaced and even more recruited, it has implications for patients, practices and an already overstretched out-of-hours service.

As the Minister of State will be aware, Kildare has one of the fastest growing population centres in the country, with an increase of 5.6% according to the 2016 census, the third largest growth nationally after Fingal and Meath. That percentage represents an extra 11,800 people living in Kildare since 2011. It is estimated that every 2,500 in population growth in the county creates the need for a new GP, which means that almost five new GPs are now needed in addition to our 2011 numbers.

The programme for a partnership Government emphasised the need to focus on enhancing primary health care services, including by building up GP capacity and increasing the number of therapists and other health professionals in primary care. In order to do this while also investing in primary care centres, we must ensure that we can attract and retain more young doctors to work as GPs. Specifically, I want to ensure that Kildare has a sufficient supply. We are lucky to have 20 GP trainers operating in the county. They are spread across a variety of schemes - midlands, midlands-Naas, Royal College of Surgeons in Ireland, RCSI, TCD and UCD. It is this spread that is the crux of the issue. While these programmes get all of the benefits of the Kildare GP community and the KDOC out-of-hours service, Kildare itself does not retain enough graduates to meet future demand.

Internationally, it has been shown that the presence of a local and identifiable GP training programme is an effective way of doing this. County Donegal is a good example. One would imagine that, due to geographics, it would be harder for that area to retain GPs after training than it would be for somewhere like County Kildare, yet Donegal exceeds the national average of GPs per population because it has its own identifiable training scheme.

During recent presentations on the future of health care, Professor Susan Smith stated that one of the solutions to the issue of GP retention was providing targeted GP training in areas where GPs were needed. I would like to see a GP training programme in County Kildare to help retain GPs. The necessary skills and infrastructure are already in place, so this measure should not have a significant additional cost. I understand that a reorganisation of GP training has been proposed for 2018 when the Irish College of General Practitioners, ICGP, will take over from the HSE. This is an opportunity for Kildare to have our own training programme. We would welcome the Minister of State's support in this regard. The programme would have the support of the majority of Kildare GPs and GP trainers and would be of significant benefit to Naas General Hospital, as trainees would spend two years on hospital placement.

I will outline the pressure that our GP services are under. KDOC deals with 60,000 clients per year. This phenomenal figure shows the level of work involved, but we will need to be able to increase our numbers in light of our growing population. The age profile of GPs is heading in the wrong direction.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Heydon for raising this important issue. I commend him on his work and interest in GP training in particular and on his views on and support for developing our GP services and, more generally, the national health service. I assure the House that the Government is committed to ensuring that patients across Ireland continue to have access to GP services, especially in remote rural areas and disadvantaged or socially deprived ones.

Several efforts have been undertaken in recent years to ensure that general practice remains an attractive and rewarding career option and to attract more GPs into the workforce. These include: changes to the entry provisions to the General Medical Services, GMS, scheme to accommodate flexible-shared GMS-GP contracts and the extension of the retirement age for GPs under the GMS scheme to 72 years; an increase in the annual number of GP training places; and the introduction of an enhanced supports package for rural GP practices. In addition, proposals are being developed to introduce supports for GPs working in areas of social deprivation as part of the GP contracts review process. A mapping exercise is under way and will inform the setting of eligibility criteria and the actual content of the support framework. The GP contracts review process will, inter alia, seek to introduce further measures aimed at making general practice an attractive, fulfilling and rewarding career option into the future.

GPs are essential to the provision of accessible services to patients in the most appropriate setting. Increasing demands on the health system will have a major impact on the future need for GPs. The HSE's national doctors training and planning unit is working on developing detailed workforce plans for different medical specialties. Its report, Future Demand for General Practitioners 2015-2025, found that there was an under-supply of GPs. I accept Deputy Heydon's point in that regard. Medical workforce planning for general practice has, therefore, been prioritised in this context.

The HSE and the ICGP announced this year that they had reached general agreement on the future delivery of the national programme of specialist GP training by the latter. This is an important change in the way that GP training is delivered and funded and will ensure that we build more training capacity while maintaining the high quality of training required of our GPs.

The annual GP trainee intake was increased from 157 to 172 this year. This is an increase of 53 places on the number for 2010, when GP training places stood at only 119. This further step is crucial to ensure the capacity is there for GPs and primary care to take on additional responsibilities, including greater GP care coverage and the management of chronic diseases within the community rather than in hospitals. The programme for a partnership Government also recognises the need to build GP capacity and commits to increasing the number of GP training places over the next five years to 259 places annually.

GP training programmes are delivered by 14 separate GP training programmes throughout the country and are not designed along county boundaries. County Kildare does not have its own dedicated GP training programme but there are several GP trainees based in GP trainer practices in County Kildare. These trainees are principally aligned to the midlands and Trinity training programmes, with 14 in the midlands programme and four in the Trinity programme, a total of 18. The Department will continue to work with the HSE and the Irish College of General Practitioners to ensure the general public can continue to have ready access to GP services and that doctors have access to GP training opportunities.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for his response and, in particular, I welcome the increase in the number of training places that he mentioned, as well as the agreement between the HSE and the Irish College of General Practitioners announced earlier this year on the future delivery of the national programme of specialist GP training by the college. That is a positive. What I want to take from this debate is an acknowledgement that the demographics of Kildare, with such a young population that is due to age and which is consistently growing, will lead to greater demand on GP services into the future. There is an ageing aspect in our current GP services and a problem in Kildare with retention of the trainees we are putting through the system.

We have 20 trainer GPs throughout the county doing great work but we are not retaining enough of those they are training. Any GP in Kildare wants to know that when he or she retires, somebody else will take his or her place and care for patients at the consistent level shown heretofore. A rural area such as Castledermot reaches from the Wicklow border over to Athy. In places such Athy town, Newbridge, Kilcullen and everywhere in between, patients are concerned about this matter. With many families, the GP is the first port of call when anybody needs a service. KDOC is doing a fantastic job out of hours and, as I said, there were 60,000 clients last year. It is phenomenal and one of the most successful out-of-hours services in the country. With GP services, now is the time for us to plan adequately for the future. I hope that consideration will be taken as part of the realignment with the Irish College of General Practitioners. I ask the Minister of State to make the point through his good offices.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Heydon and accept his point regarding the pressure on our GP services, which we must deal with. We had some difficult times during the past seven or eight years when there has not been enough investment in the health services. I take that point. Under the programme for Government, we intend to rebuild and invest in our health services. As part of that development, increasing the number of GPs will be major part of our strategy. GPs play a major role in providing community medical services and they assist in relieving the pressure on emergency departments in hospitals as well.

I stated earlier that the development of the GP services was not designed along county boundaries. The Deputy has real concerns about this issue and spoke about Castledermot, Newbridge and Kilcullen. I will bring his views back to the Minister, Deputy Harris. If there are gaps in GP services in individual counties such as Kildare, they should be dealt with. I give a commitment that I will deliver that strong message to the Minister. I am strongly supportive of developing GP services, whether they are in Kildare or other counties. I stated earlier that we have prioritised disadvantaged areas but that is another day's work. I will commit to do my best to expand and develop those GP services.