Timmy Dooley (Clare, Fianna Fail)
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The Minister for Health will be aware that it is proposed to reconfigure the Shannon Doc out-of-hours GP services in the mid-west region, which will affect services in west and north Clare and involve the closure of services in Killaloe. This is unacceptable, short-sighted and a betrayal of people who live in rural areas. The areas of east and west Clare that are under threat as a result of the proposal to reduce services are some of the most isolated locations in terms of health care not just in County Clare but in the country as a whole. I suggest that if the Government fails to intervene in this issue, it will be yet another example of the manner in which it has turned its back on people from rural parts of the country. People in rural areas should expect to be able to access the same health services as those living in towns and cities. I refer, in particular, to those who have access to such services.

The out-of-hours Shannon Doc scheme has worked very well by treating patients in their communities. I do not doubt that any attempt to undermine the availability of access to Shannon Doc services on the part of rural communities will lead to delays in diagnosis and will place greater pressure on the accident and emergency department at Limerick University Hospital, which is already over-stretched. The HSE and the local doctors need to sit down to thrash out this problem and find a solution other than that which has been proposed. I do not accept that a small reduction in the number of doctors participating in the scheme is enough to require the drastic closure of the service in west and north Clare and in the east Clare area around Killaloe. Equally, I do not accept that the number of patients attending these services in some way justifies the discontinuation of the current service. I appeal to the Minister to talk to the officials in the Department of Health and to put in place a forum with the GPs and all the interested parties so that a solution to this problem can be found. It is not enough to say to the people in these areas that they must all be pulled into a single area because there are not enough doctors or service users.

My local radio station, Clare FM, recently aired a report about the mother of a three year old child who suffers from severe asthma on a regular basis. When the child had an asthma attack on a recent Sunday night, this woman and her child rushed to the out-of-hours GP service in Kilrush and the child was successfully treated with a strong dose of nebulisers. The nature of what happens to asthmatic children means that this mother and many others regularly need to make such visits. She is deeply concerned about what will happen when such an event in the life and the health of her child occurs again. She absolutely believes she would not have time to get to Ennis, or perhaps Milltown Malbay as is now proposed. Therefore, the closure of the service in Kilrush has the potential to have a very negative impact on her family. The same concerns are being expressed in Ennistymon and Killaloe for a variety of reasons.

This service is funded by the State. This model was put in place to eliminate the need for people to present unnecessarily in accident and emergency departments. That is something we all talk about and we all need to see happen. We are attempting to solve a problem that does not exist in a way that will ultimately drive more people into our accident and emergency services at a time when they are overstretched, overburdened and unable to cater for and cope with the demand that exists. I appeal to the Minister to put the thinking caps on in the Department of Health so that some level of sanity can prevail.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Dooley for raising this important issue. I can hear the anxiety he has conveyed on behalf of his constituents. That would be replicated by any of us in these circumstances. As the Deputy knows, GPs who are contracted under the General Medical Services, GMS, scheme must make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside normal practice hours. While there is no obligation on GPs to participate in GP out-of-hours co-operatives as a means of meeting the contractual requirement, such services have been developed and expanded over time and are now an essential part of our primary care services. This helps to ensure to the greatest extent possible that urgent care needs are met in the primary care setting.

As the Deputy knows, out-of-hours arrangements in the mid-west region are discharged through Shannon Doc, which is a not-for-profit GP co-operative funded by the HSE. Shannon Doc recently announced that due to a difficulty in attracting GPs, and in particular locum cover, it is no longer able to maintain its existing service across all its centres. Following discussions with Shannon Doc, and in order to ensure the sustainability of the service, the HSE accepted a proposal from the co-operative to change the provision of the service. The most significant changes relate to parts of east and west Clare, essentially affecting Ennistymon, Kilrush and Killaloe, with minor changes in operating hours at two locations in north Tipperary. The Government is committed to ensuring patients throughout the country continue to be able to access GP services, especially in remote rural areas and certain disadvantaged urban areas. It is also committed to ensuring general practice is sustainable in such areas into the future. It is imperative that existing GP services in these areas are retained and that general practice remains an attractive career option.

The development of primary care is central to the Government’s objective to deliver a high-quality, integrated and cost-effective health care system. There is a commitment in A Programme for a Partnership Government to a decisive shift within the health service towards primary care to deliver better care close to home in communities across the country. The programme for Government emphasises the need to focus on enhancing primary health care services by building up GP capacity, increasing the number of therapists and other health professionals in primary care and continuing to expand the development of primary care centres and facilities. The annual GP training intake has increased from 120 prior to 2010 to 172 this year. I know the Minister, Deputy Harris, is anxious to achieve further increases in future years. The Minister has emphasised the need for a new GP services contract which will help to modernise our health service and develop a strengthened primary care sector.

Health service management has made progress with a number of significant measures through engagement with GP representatives. The GP contracts review process will, among other things, seek to introduce further measures aimed at making general practice a fulfilling and rewarding career option into the future. Progress to date includes changes in the entry provisions to the GMS scheme to accommodate flexible or shared GMS-GP contracts, and an enhanced supports package for rural GPs which includes a change in the qualifying criteria for rural supports and an increase in the financial allowance from €16,216 to €20,000. The recent changes to the Shannon Doc out-of-hours service will be subject to a three-monthly review. Their impact will be closely monitored and evaluated by the HSE. I hope the Deputy finds this information helpful.

Timmy Dooley (Clare, Fianna Fail)
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I accept that the Minister of State is here on behalf of the Minister for Health. I think she has been as frank as she could be. She touched on the nub of the issue when she spoke about GP contracts. She said that while this is a contracted service, GPs under this contract "must make suitable arrangements" to deal with out-of-hours services. I share the view of many people in the Clare constituency that the solution which has been arrived at is not suitable. The proposed arrangement is not fit for purpose, does not meet the needs of the community and does not ensure safe outcomes for patients who encounter issues like those I have already mentioned. I do not doubt that it will delay some patients in getting access to the treatment they need to save their lives. In other circumstances, it will delay people as they seek to present themselves to the medical system. Invariably, this will mean they end up in accident and emergency units. Some people will require hospital stays as a result of delays in getting to see doctors in the first instance. That is going to put more glue in the cogs of the health system in the mid-west.

I appeal to the Minister of State to go back to the Department to see whether the HSE will reject the proposal that has been made by the doctors. I was taken aback to discover that the HSE had accepted the proposal presented by the doctors. If the appropriate checks and balances had been put in place, and if the interests of the patients whom the doctors are supposed to serve had been taken into account, there is no way the HSE would have accepted this proposal.

In my view, they should have gone back to the general practitioners and the people who run this service and made the case that it was not acceptable, that it does not meet the needs and that it is not a suitable arrangement. Furthermore, they should have made the case that the Minister must put in place an appropriate service and work with them to find a suitable solution.

I appeal to the Minister of State to go back to the HSE, re-engage with the doctors and try to ensure we have a system that is fit for purpose, one that meets the needs of the patients and one to ensure that we do not further clog up the accident and emergency departments, which are under such extraordinary pressure at the moment.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I wish to reassure Deputy Dooley that I will certainly convey his strong and articulate feelings on the matter to the Minister and the Health Service Executive. The challenge facing Shannon Doc, as I am advised by the Health Service Executive, is that the operation is in this predicament due to a shortage of doctors. As a result, Shannon Doc simply cannot maintain the services. I have been told that the Killaloe service will be open during weekdays on a needs basis with a mobile doctor servicing the centre. At weekends, the operating hours will change between 9 a.m. and 9 p.m. to between 2 p.m. and 6 p.m. Patients will be seen at the Limerick, Ennis and Nenagh centres outside those hours. The Kilrush Ennistymon service will relocate to Milltown Malbay during weekdays with the same operating hours applying, and both centres will be operational on Saturday and Sunday up to 7 p.m. instead of up to 9 p.m. I know that is not what Deputy Dooley wanted to hear, but I am afraid that is simply the way things are at present.

I am further advised that the HSE grant aids Shannon Doc to assist in its operations and that the changes decided by Shannon Doc are not influenced by funding availability provided by the Health Service Executive.

I assure Deputy Dooley that I will certainly convey his disquiet and that of his constituents on this issue to the Minister and the Health Service Executive. Our aim in this regard is to see if further efforts could be made to ensure the services people were used to - Deputy Dooley referred to a particular case - could be provided to his constituents.