Aindrias Moynihan (Cork North West, Fianna Fail)
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I am raising this issue because so many people, especially newer people in the Macroom area, are finding it increasingly difficult to get a local GP service. They are being refused because GPs are already overloaded. They will often have to stay with their existing GP who could be many miles away in Killarney, Mallow, Ballincollig or anywhere up the country if they have moved to Macroom. While that is a concern, it is when they need access to the GP that it hits home, for example, if they are working in Cork and there is a sick child in school who has to come out to Macroom and turn around and possibly go back into Cork or all the way up to Mallow to their GP, or even if they are sick themselves.

I have raised this issue before and at the time the expectation was that the new GP contract would address the situation, but it has not. New people are still struggling to get cover. Many of them are travelling longer distances. People are having to pay for blood tests. Outreach clinics are not available such that, for example, a person in Ballingeary whose GP is in Macroom has a 60 km return journey to get to that GP. Out-of-hours services are being provided out of Bandon, 30 km away, causing further distress to locals.

I recognise that there are GP issues throughout the country for different reasons, but there are local issues that are having an impact in this situation. Unique local issues are making it more difficult for residents and for the GPs themselves. There is a very onerous out-of-hours cover rota, at one in seven. This very much contrasts with the rota of one in 30 in the adjacent cell in Cork. It means that a Macroom GP is expected to be on call at night-time and weekends four times more often. He or she will provide cover once every seven days. That discourages new GPs from taking up a position there. There is no rural practice allowance allowed in Macroom despite the fact that the Macroom service covers a very large rural area, from the Lost Valley to Mullaghanish and around to Barrahaurin. This is happening at a time when the population of the town has grown but there is no increase in the number of GPs.

This came to a head again recently when there was a retirement, posts were advertised and only one person came forward for the first round. Following more recent advertising, no interest was expressed in it. It is quite possible that it could go on being advertised for some time before a GP will come forward. As the Minister of State can imagine, this is all putting pressure on locals. It is also putting considerable pressure on the GPs. I acknowledge the significant work that GPs are doing locally. In fairness, they are still capable of providing a same-day service. That is important to acknowledge. However, that can only last for so long. There is phenomenal pressure where people are having to travel further for a GP. People coming into the area are not getting access to a local GP.

A total of €40 million is being set aside in the current budget for enhancement of GP services. There are also commitments on supporting various GP services and supporting SouthDoc and the various organisations around it. In the interests of supporting communities such as Macroom, which are finding it ever more difficult to get GP cover, will the Minister of State raise the issue with the senior Minister and can we in some way or other advance the situation so that people can expect to get access to a doctor in their own locality?

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Moynihan for raising this important issue relating to Macroom. I assure the House that the Government is committed to the continued development of GP capacity to ensure that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas in the future. The Minister for Health is working to ensure that existing GP services are retained and that general practice remains an attractive career option for newly qualified GPs.

The number of GPs on the Medical Council's specialist register continues to increase, from 2,270 in 2010 to 3,857 as of mid-October. The number of GPs holding General Medical Service, GMS, contracts has also risen from 2,098 in 2008 to almost 2,500 in 2019.

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. These include changes to the entry provisions to the GMS scheme to accommodate more flexible 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, as well as the introduction of enhanced supports for rural GP practices. GP training places have also increased from 120 in 2009 to 192 places filled in 2019, an increase of 60% over this ten year period. In addition, the recent agreement on GP contractual reform will benefit patients and GPs.

In return for co-operation with a range of service developments and reforms, the Government will increase investment in general practice by approximately 40% or €210 million over the next four years. There will be increased support for GPs working in rural practices and for those in disadvantaged urban areas. Improvements in the maternity and paternity leave arrangements have also been agreed, in recognition of the need to ensure that general practice is compatible with doctors' family-friendly commitments.

I am confident that these measures will help make general practice a more sustainable and attractive career option for doctors.

In respect of Macroom, and I understand the valid point the Deputy is making, I understand that the GPs and the out-of-hours co-operative are reporting a significant increase in demand for their services. In addition, the retirement of a single-handed GP in the town has added to the difficulties. I accept the Deputy's point in that regard. The panel has been advertised on two occasions but has not been filled. It is currently being advertised again, both in Ireland and internationally. A locum GP is in place since 16 September and is providing services to general medical services, GMS, scheme and private patients. All other practice staff - the nurse and the secretary - remain in place, funded by the HSE. A locum doctor will continue to be funded until the post is filled.

The GPs in Macroom also provide out-of-hours services. That is managed by SouthDoc, with which HSE Cork Kerry Community Healthcare has a funded service level agreement in place. Supports have been put in place to reduce the GP out-of-hours commitment by funding locum cover for Sunday shifts. Work is ongoing to reduce further the out-of-hours commitment of the Macroom GPs.

To follow up on the points made by the Deputy, it is essential that we all work closely together on this issue. I will raise the Deputy's concerns with the Minister, Deputy Harris, particularly in respect of Macroom because the case he made is genuine. We have a problem filling the vacancies. The HSE has advertised them nationally, and it may have to do so internationally, to get the GP in the town but the people of Macroom deserve the right to have a proper GP service.

Aindrias Moynihan (Cork North West, Fianna Fail)
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I thank the Minister of State. There is quite a lot in the answer but I stress that people need to be able to expect to have a GP service locally and not have to crisscross all over the country.

Finian McGrath (Dublin Bay North, Independent)
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The Deputy is right.

Aindrias Moynihan (Cork North West, Fianna Fail)
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There are difficulties across the country but I need to be sure that the Minister of State recognises that local issues are making it more difficult for people to access GP services in Macroom than anywhere in else in the country. What we are looking for is to be able to compete on a level footing to fulfil that vacancy. The out-of-hours rota in the area, at one in seven, is over and above what would be expected anywhere in the country. It means that a Macroom doctor is expected to be on call four times more often at night and at weekends than a colleague in Cork, which is just down the road, who is on a rota of one in 31.

I refer to the absence of the rural practice allowance. The Minister of State referred to increased support for GPs working in rural practices and those in disadvantaged urban areas but that does not apply to Macroom. Macroom does not have that status despite the fact that it has a very large rural hinterland. There are unique local issues in Macroom that are relevant. The recent retirement merely illustrates the difficulty that has existed in recent years, which I have highlighted here on previous occasions.

What we are looking for in Macroom is a level playing field to ensure the obstacles that are unique to Macroom - the out-of-hours service and the absence of a rural practice - will be addressed. In that way, people advertising for a Macroom job would have an equal standing with every other area in the country. It would mean also that locals would have a real expectation that there would be a GP available to them and that they will not have to crisscross the country for such a service.

I will give the Minister of State an example of a lady who travels to and from Kildare every month where she had her GP service until now. That does not make sense. There are people from Cork, Tralee and across the country because they cannot get a service locally. It needs to be tackled.

Finian McGrath (Dublin Bay North, Independent)
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Absolutely. I reiterate the Government's commitment to ensure that this happens. I take the Deputy's point about having to crisscross the country and also the unique local issues in Macroom. He mentioned the urban disadvantaged areas and rural areas. The issue of an out-of-hours cover rota of one in seven has to be dealt with also. I accept the Deputy's argument on the unique local issues in Macroom.

On the GP service in Macroom, I assure the Deputy that the Minister, the HSE and I are committed to working with the local GPs in the area to resolve the current difficulties to ensure that services can continue to be provided to the local community. I strongly believe in having local services in communities. The example given by the Deputy of one of his constituents having to travel to and from Kildare for a service is unacceptable. I am aware the Acting Chairman, Deputy Durkan, is a prominent TD in Kildare. I accept the Deputy's point that it is unacceptable that situation has arisen. The HSE is trying very hard to fill the positions. We have to make this a priority. I will raise the Deputy's concerns with the Minister, Deputy Harris, and the HSE.