Mattie McGrath (Tipperary, Independent)
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I am to share time with Deputy Butler. Fourmilewater Health Centre, which is located just across the border from me in County Waterford, serves the parishes of Ballymacarbry, my own parish of Newcastle in County Tipperary, The Nire and Ballinamult, Tooraneena and even further afield. It is a wonderful rural general practitioner, GP, service with 1,700 patients, 1,050 of which are private patients so this is a very viable service. Since the resignation of the former GP linked to the service, Dr. Janes, who resigned in April of this year, the service has been operating with a locum GP service and there has been significant concern about the future of the health centre. I thank Dr. Janes and his staff and the previous doctor, Bill Donovan, his good wife and his receptionist who worked there for years. They gave decades of service. In June the post of a full-time GP for Fourmilewater Health Centre was advertised with a successful applicant being offered a position in July. It is my understanding that the successful applicant accepted the position in August. However, to date contracts have not yet been signed. There is a concern that the successful applicant wants to reduce this service to a part-time service operating a morning-only service thereby bringing his patients to his current practice in Clonmel, which would be a problem for the many patients who would have to travel significant distances to Clonmel, some of whom do not have cars and could not get taxis. It is my understanding that there were four applicants for the position. What is the delay in having the contracts signed and getting the new GP in place? If the successful applicant is no longer interested in providing a full-time service at Fourmilewater Health Centre why has the Health Service Executive, HSE, not moved on to offer the position to the next in line on the panel?

Fourmilewater Health Centre is in a very fortunate position whereby it is deemed to be viable and received significant interest from GPs, which is rare in the current circumstances. If the doctor selected is no longer interested in providing a full-time service, which the HSE informs me it is committed to providing, why is there a delay in moving forward by selecting a new candidate? As there is no GP service in Clonmel or Dungarvan that will have the capacity to take on 1,700 patients, a full-time service in Fouremilewater is vital.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Mattie McGrath for the time to speak on this issue. The Fourmilewater Health Centre is located near Ballymacarbry, County Waterford, close to Clonmel. It is a rural practice which provides essential medical care to the local community in Waterford and south Tipperary, and has over 1,700 patients. The previous GP at Ballymacarbry Fourmilewater Health Centre was on sick leave in October 2017 and subsequently resigned his list. The vacancy for the GP position was advertised in June of this year. The staff at the practice have consistently worked with HSE officials to source a locum until a permanent replacement was identified. This has been done on a piecemeal basis for the past 12 months in order to give the patients continuity for this vital service. It is an extremely rural area. This was and continues to be an additional workload for all the staff located at the centre.

Bearing in mind that the practice has been without the appointment of a full-time GP since October 2017 and even though the position of a full-time GP was advertised in June, the practice is still waiting for that appointment to be made. I understand there were several applicants to the position and a panel has been created. Interviews were held in July and we still await confirmation of the appointment today. It is causing huge uncertainty and distress to many patients and to staff members, who have worked tirelessly to keep the health centre open and operating until a replacement can be identified.

Catherine Byrne (Dublin South Central, Fine Gael)
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I am taking this matter on behalf of the Minister for Health, Deputy Harris, who unfortunately cannot be here. The Government is committed to enhancing primary care services in Ireland and to engaging with GP representatives on necessary service improvements and contractual reforms that will enable GPs to better meet the needs of their patients, while promoting general practice as a viable and rewarding career for both existing doctors and future medical graduates.

Agreement on the delivery of these much-needed measures and reforms has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis. The goal is to develop a contractual framework that has a population health focus, providing in particular for health promotion, disease prevention and for the structured care of chronic conditions, while ensuring patients throughout the country continue to have access to GP services. The Government is aware of workforce issues facing general practice, including the influence of demographic factors and in recent years has implemented a number of measures to improve recruitment and retention in general practice.

GP training places have been increased from 120 in 2009 to 193 places in 2018, an increase of around 60% over this nine-year period. As stated in the programme for Government, the intention is to continue to achieve annual increases in the number of training places available. The number of GPs on the specialist register continues to increase, and has risen from 2,270 in 2010 to 3,700 as of September 2018. The number of GPs holding General Medical Services, GMS, contracts has also risen from 2,098 in 2008 to 2,508 as of October 2018. Entry provisions to the GMS scheme have been changed to accommodate more flexible GMS contracts and the retirement age for GPs has been extended to 72. An enhanced support package for rural practices has been introduced with improved qualifying criteria and an increased financial allowance of €20,000 per annum.

The HSE is fully committed to continuing to provide full GP services from the Ballymacarbry Health Centre. Following the retirement of the previous GP in Fourmilewater in July, the HSE made arrangements for a locum full-time GP to be put in place. GP services in this practice continue to be maintained and the existing practice staff members have remained in their respective roles.

The HSE has advised that a recruitment campaign has been run to fill the current general practitioner, GP, vacancy. That process is now in its final stages and the HSE is seeking to agree a start date for the replacement GP.

I reiterate the Government's commitment to ensure that patients throughout the country will continue to have access to GP services and to reaching an agreement with GP representatives on necessary service improvements and contractual reforms. I will come back on some of the questions raised by both Deputies.

Mattie McGrath (Tipperary, Independent)
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With no disrespect to the Minister of State, it is typical for her to come in and read out a reply on behalf of the Minister which is useless, toothless and fruitless. We are worried. Some 1,700 patients and their families are very worried. I pay tribute to the staff and the nurses who have kept the centre going, including the person who comes in to my own parish on a locum basis, Ann-Maria Byrne. The people concerned do not want this kind of report on statistics about GPs and such. They want a service. Four GPs applied for it. If this doctor wants to subsume the practice into Clonmel, it should not be allowed. It is 12 miles away, there are no taxis and many people do not have cars. The HSE must move on. He is having meetings and negotiations with the HSE. The date for signing a contract has been passed a few times and they missed it. We want clarity and certainty, and we want the patients of Ballymacarbry, Newcastle, Tooraneena, Ballinamult and beyond to have the service they are entitled to. We want the staff to have some future. It is an excellent, top-class facility with a top-class service. All we want is a GP appointment that will not diminish the service and subsume it into a bigger practice in Clonmel. Most GPs in Clonmel cannot take one patient, never mind 1,700. We need clarity, honesty and the people to be reassured that they will have a GP service.

Mary Butler (Waterford, Fianna Fail)
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It was evident months ago that the practice was losing its full-time GP. The patients and I are asking why the recruitment process is taking so long. Full-time services were always provided in the Fourmilewater Health Centre. They must continue to be provided for in this rural area. I cannot stress enough how rural the area is. The Minister of State can understand, with 1,700 patients coming here every day of the week, that they are very concerned. They are genuine concerns. There is a genuine fear that this service will be downgraded to a two or three day service. The Minister of State mentioned general practice. We all know that rural general practice is in decline and in crisis. We cannot allow this practice to be lost. We will have to fight tooth and nail for it.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Deputy.

Mary Butler (Waterford, Fianna Fail)
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We would like the answer.

Catherine Byrne (Dublin South Central, Fine Gael)
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I just have a short answer, if that is okay.

Bernard Durkan (Kildare North, Fine Gael)
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Sorry about that.

Mattie McGrath (Tipperary, Independent)
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A direct answer will do for us.

Catherine Byrne (Dublin South Central, Fine Gael)
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I can only reply with the answer I gave the Deputies. I have taken notes. I do not know whether I made a mistake or not, since according to this there is a full time practice but I may have heard that it has been reduced to a half-time practice. Did I hear that right?

Mary Butler (Waterford, Fianna Fail)
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It is a full-time practice but the concern is that it might be reduced to a part-time practice.

Mattie McGrath (Tipperary, Independent)
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It has 1,700 patients.

Catherine Byrne (Dublin South Central, Fine Gael)
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I have taken notes and listened to the concerns of both Deputies. I will go back to the Minister, Deputy Harris. Unfortunately, he has had to go to something else. I will raise the serious concerns that both Deputies have if this service is moved out and goes to another area. Many people will have to be facilitated in even just trying to get to a place from where they are. I am not familiar with the site in question but I am familiar with Clonmel.

Mattie McGrath (Tipperary, Independent)
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The Minister of State is welcome to come and see it.

Catherine Byrne (Dublin South Central, Fine Gael)
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I will ask the Minister to reply to both Deputies, if that is okay.

Mary Butler (Waterford, Fianna Fail)
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I thank the Minister of State.