Andrew Doyle (Wicklow, Fine Gael)
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Roscommon is getting a good look in today.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Indeed, on two very important issues. I am sure the Minister of State, Deputy Jim Daly, is glad we are not coming back to him about the Rosalie unit on this occasion. Deputy Naughten and myself will be coming back to him on that as well.

Denis Naughten (Roscommon-Galway, Independent)
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We will.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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It is fair to say that general practice is under pressure up and down the country. We have seen the protest from the doctors and the concern expressed. It is no different in the constituency of Roscommon-Galway. One general practitioner based in the constituency has been asked to take on additional patients, as many doctors have been, from the primary care reimbursement service, PCRS, panel appointments. Recent protests have highlighted the ongoing pressures being placed on GPs throughout the country. This particular GP in my constituency is unfortunately not unique. His practice is operating at full capacity and there is now a three-day waiting list for his surgery. His existing patients are deeply frustrated by the situation. Despite this, a number of additional patients have been assigned to him by the PCRS. His practice nurse has been on maternity leave since December and he is having serious difficulty in sourcing a full-time nurse and has not been successful to date. As a single-handed GP who also took patients from the emergency reception and orientation centre, EROC, in Ballaghaderreen, he should be excluded from patient appointments in his panel. He has been asked to take on new patients on a regular basis over the past two years due to a number of issues such as Brexit, people relocating to the west and people coming back to the area to work. There was already extraordinary pressure on this GP prior to the arrival of patients from Syria.

As for the EROC, despite the promises from the Government and the Department of Health, no new resources or funding were allocated to the Ballaghaderreen area to support the existing health services, and now we can see the fall-out. If this GP takes additional patients, they will more than likely end up being assigned to another GP after six months. GPs are entitled to ask for patients to be moved on if they cannot handle the situation. This would be very frustrating for the doctor and the patients, particularly in a place like Ballaghaderreen where a doctor and his staff genuinely took on the people from the EROC, gave a fantastic service to those people and continue to do so without any assistance from the Department. He is still not able to do it and he is totally frustrated. I have a copy of a letter from the HSE telling him that another family is coming. I am not going to give the details here but I have them on file if the Minister of State wants to see them. This is happening on a constant basis and it is not fair to him.

The doctor writes that the HSE contacted him last year to take on a family that was moving to the area from the Mosney centre and was being settled in the town of Ballaghaderreen. He says he was unhappy at the time due to the fact that this placed an even greater burden on the surgery but, once more, he accepted the new patients. He states that he thinks this is very unfair as there were already extraordinary pressures on the surgery prior to the arrival of the patients from Syria. He writes that his practice provided a GP service to those vulnerable patients and that it was the proper and Christian thing to do. That is what the GP wrote in a letter to me. It is clear that there was extraordinary goodwill to help less fortunate people. He never closed his door on them. However, when people now look to make an appointment, including patients who have been with him for years, in most cases he cannot take them until the following week. Where there are EROCs and direct provision centres and doctors are being asked to take on these extra patients, I ask that we do something for them because no back-up has been given to them.

Jim Daly (Cork South West, Fine Gael)
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I assure the House that the Government is committed to the continued development of GP capacity. The goal is to ensure patients across the country continue to have access to GP services and that general practice is sustainable in all areas into the future. GPs have a crucial role in the provision of primary care services. Particularly in rural areas, local GPs play a vital and ongoing part in the lives of most people in the community. I want to ensure that existing GP services are retained and supported and that general practice remains an attractive career option for newly qualified doctors.

I understand that there are two General Medical Services, GMS, GPs in Ballaghaderreen. In addition to their medical card and private patients, these GPs provide care to refugees in the emergency and orientation centre in Ballaghaderreen. While neither of these GPs has GMS panels exceeding the maximum number of patients permitted under the GMS scheme, the HSE is aware that they are under pressure to provide such services but has not been made aware of any particular difficulties in this regard. Local HSE management in Roscommon is committed to liaising with the two GPs on an ongoing basis in respect of the provision of services to patients in Ballaghaderreen.

The Government is aware of workforce issues generally facing general practice, including the influence of demographic factors, and has implemented a number of measures to improve recruitment and retention in general practice. These include changes to the entry provisions to the GMS scheme to accommodate more flexible or shared GMS GP contracts, and to the retirement provisions for GPs under the GMS scheme, allowing GPs to hold GMS contracts until their 72nd birthday. Enhanced supports for rural GP practices have also been introduced. These steps should help to address the future demand for GPs by enticing GPs who may have ceased practicing for family or other reasons back into the workforce, facilitating GPs to work past the standard retirement age and encouraging more GPs to work in rural areas. There has been a huge expansion in the number of training places on GP training programmes in recent years. In 2009, there were 120 GP training places available and in 2018, 193 places were filled, an increase of approximately 60% over this nine-year period.

It is acknowledged that there are many challenges in general practice. That is why the Government remains committed to engaging with GP representatives on the development of a package of measures and reforms to modernise the current GMS contract. Talks between the Department of Health, the HSE and the Irish Medical Organisation as the established GP representative body are continuing. Agreement on the delivery of these service improvements and contractual reforms has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State for a fairly comprehensive reply. Obviously, I cannot be happy with it. The reply states: "While neither of these GPs has GMS panels exceeding the maximum number of patients permitted under the GMS scheme, the HSE is aware that they are under pressure to provide such services but has not been made aware of any particular difficulties in this regard."

However, this GP contacted the primary care reimbursement service, PCRS, and said that he was unable to continue to take patients like this. He has told me that he will have to move those patients on after six months. This is an unsatisfactory situation.

These are exceptional circumstances. Ballaghaderreen is a town that accepted less fortunate people with open arms. Everyone played his or her part in that, along with the Minister of State, Deputy Stanton. I thank the Minister of State for his engagement on that. However, when questions were asked at the time, we were told quite clearly that if extra support was required in the area of health or education, it would be forthcoming. I can tell the Minister of State that if it was not for the volunteers and doctors in Ballaghaderreen, those people would not have a great existence. They constantly look after them and provide services to them. They do it because they say it is the Christian thing to do. I ask that the Minister of State bring the message back to the Minister for Health, Deputy Harris, that when people from places like Syria are brought into direct provision centres, we must provide the locality with some extra services. We should look at that proposal. A special case should be made for towns like that, and for GPs who are caught in those situations. They cannot cope, and that is the bottom line.

Jim Daly (Cork South West, Fine Gael)
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I take the points the Deputy has made on the reception centres and the orientation centre in the town, and the additional strain it has put on existing GP practices. I will relay those concerns to the senior Minister and the HSE on foot of what the Deputy has raised here today. I urge the GP to return to the primary care unit locally. As the Deputy will appreciate I cannot address the detail on a local scale, and can only speak about national policy issues. The HSE primary care unit would be the appropriate place to have further discussions. I will pass the concerns on to the HSE at the national level and relay them to the senior Minister.