Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I am not sure if the Minister of State is aware of the issue involving over-capacity difficulties regarding children under six for GP care. The reality would have been lost in a lot of the hoopla, backslapping and self-congratulation that went on around the granting of medical cards to children under the age of six. The unfortunate reality is that the failure to plan on the part of this Government and that which preceded it has now manifested itself. In north county Dublin, it is quite a feature but especially so in the town of Balbriggan. The latter has a very young population and we can expect to see a surge in the number of children under six in the next couple of years.

By way of illustration, I will speak about a woman I know called Louise - we have the same name. Louise is married and has three children, two of whom have special needs. She can practically see a doctor's surgery from her home but her children and her family are registered with a doctor in Malahide. Should her young children require the services of a GP, they must travel from Balbriggan to Malahide. As they do so, they drive past dozens of doctors' surgeries. The surgeries in Balbriggan are full to capacity. It is not possible for a large number of parents such as Louise to be able to access those services because they are full to capacity. Louise, therefore, has a choice. When one of her young kids has an ear infection or something that would require a visit to the GP's office she can bundle her family into the car and face in to the inevitable traffic, and all that goes with it, to see the GP in Malahide or she can put her hands in her pocket to find €45, go across the road and try to see the local doctor. If she is lucky, she will get an appointment after two or three days. Louise is not unique in this regard. This is an everyday occurrence. Parents cannot find a doctor willing to take them and, therefore, they cannot register. Their children do not have access then to the GP services that the Minister of State and the people who sit on that side of the House were busy high-fiving each other about and congratulating each other on granting. It is utterly useless to people in Balbriggan who cannot register with their GP and who are left without these vital services.

Families are being forced to spend money they do not have for a service of which the Minister of State is busy telling them they can avail. They cannot avail of it. I want to know what will be done to alleviate the pressure because it is not going to go away. If anything, it is actually going to get worse.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy O'Reilly for raising this issue. At the outset, I assure the House that the Government is committed to ensuring that patients across the State continue to have access to GP services. There have been significant developments in the general practice service recently, with more services being made available to our citizens and additional support provided by the Health Service Executive, HSE. The first two phases of universal GP care without fees were successfully introduced in 2015, first, for children under the age of six years and, second, for all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees and without having to undergo a means test. The introduction free GP care for children under six represents a major step forward in improving access, quality and affordability of health care in Ireland. The service contract for GP care without fees for those who are under six, which includes age-based preventive checks focused on health and well-being and a cycle of care for children with asthma, underlines the Government’s commitment to enhancing primary care and keeping people well in their own communities.

I would like to take this opportunity, on my behalf and that of the Minister for Health, to acknowledge the contribution of GPs to meeting the heavy demand on our health service during the peak winter period. The management by GPs of seasonal pressures, which include many patients presenting with exacerbation of chronic conditions is an example of how primary care plays a critical role in our health care system. I am also conscious that general practice does not take an extended holiday over the Christmas and New Year period and that GPs were dealing with a substantial workload while many other people were able to enjoy some time off. It is important to recognise the commitment of GPs to ensuring a responsive, accessible and high-quality service to patients on a year-round basis.

The Government is committed to the continued development of GP capacity and in 2017 the training intake will increase for the second successive year, from 172 to 187 places. Engagement is also commencing this month with GP representatives in the development of a new and modernised set of contractual arrangements for general medical services, GMS, and other public GP services. To date, approximately 94% of GMS GPs have entered into agreements with the HSE for the provision of services to children under six. Currently, almost 364,000 children under six have access to GP care without fees through a medical card or GP visit card.

I will now turn the Deputy's area, about which I know she is concerned. There are currently eight GPs who hold GMS contracts in the Balbriggan area, of whom six also hold contracts for the provision of services to children under six years of age under terms agreed with the Irish Medical Organisation, IMO, in 2015. It would be preferable if all GPs who hold GMS contracts also agreed to hold contracts for GP care without fees for children under the age of six. Nationally, the HSE has recently written to those GMS GPs who have not yet signed up to the under-six contract, and have provided them with a copy of the contract and the form of agreement for their consideration. I hope that those GPs who have not yet signed up to offer this improved and expanded primary care service will do so and ensure that all children aged under six are easily able to access GP services without, as the Deputy stated, their parents or guardians having to pay a fee or travel long distances to access care.

The HSE is not aware of any instances where GPs in the Balbriggan area have declined to accept under six year olds onto their panels. GMS GPs, however, manage their own panels and may, on occasion, close them to new patients if they consider that they have reached the limit of their practice’s capacity. I would add that no GP in the area has reached the maximum permitted number of patients an his or her panel. Where a GMS patient experiences difficulty in finding a GP to accept him or her as a patient, and has unsuccessfully applied to at least three GPs in the area who are contracted to provide services under the GMS, then the HSE will assign that person to a GP's GMS patient list. I hope this is of help to the Deputy.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The short answer is that it has not really helped. It does not solve the problem this morning, this afternoon, this evening or tonight when people are going to need to see their GPs. It is all very well to say there are X number of children in the system who are eligible for access to this scheme but it is actually completely useless to those people who simply cannot access it. I wonder if the Department of Health would give some consideration to reimbursing those parents who, through no fault of their own, cannot access the medical card for under sixes and are forced to pay because the service is not available in their areas? The Minister of State said that the HSE is not aware of instances in Balbriggan but in the next breath she asks how the HSE could be aware of the position, particularly as GPs manage their own panels. I have made the Minister of State aware of the facts.

If the Department of Health is aware, then I - and the people in Balbriggan who are waiting - would like to know what exactly the Minister of State can do to alleviate this problem in the short term. It is not acceptable that there are chronic waits. Quite apart from the fact that people cannot get these medical cards, they also cannot get appointments to see GPs in Balbriggan for two, three or four days. The GPs are already overburdened. I absolutely join the Minister of State in lauding the commitment of GPs. They do a fantastic job but they are only human. They are up to the limit of their capacity. We need to incentivise general practitioners to go to the areas they are needed and we must have salaried GPs if that is what is necessary. In the short term, we need to reimburse people who, through no fault of their own, are forced to attend and pay for GP services for children under six.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Deputy O'Reilly suggested that doctors' surgeries in Balbriggan are full to capacity.

The HSE primary care unit is not formally made aware of instances where a GMS-registered GP is refusing to attend to any children aged six and under due to over-capacity. I accept the Deputy's bona fides in this matter and will convey her concerns to the primary care unit. For people who are finding it difficult to get on a GP's GMS patient list, they should contact the primary care unit and give details of the GP who is saying he or she is full to capacity. The unit will assign that individual to a specific GP. There is a route there to access care. I am advised by the HSE that two GPs in Balbriggan have not signed the under sixes contract. I will convey the Deputy's concerns on this matter.