Seán Sherlock (Cork East, Labour)
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I first wish to express my concern at reports that the out-of-hours GP services in the Fermoy and Mitchelstown area will cease shortly. We are being told that a stricture is being put on that service on the basis that if a GP is over the age of 60 or is pregnant, the service may no longer be sustainable. This is very worrying news and if taxpayers' money is being used to fund the SouthDoc service, the matter must be addressed in a way that ensures absolute transparency about the decision-making process. We do not want to see a loss of out-of-hours services in the north Cork area.

Second, the issue of section 39 organisations, which includes SouthDoc, worries us greatly. A strike will be held on Tuesday, 15 December and we express solidarity with the workers in that regard. We want to ensure those workers are paid and get their due rewards but we also want to ensure that we do not lose services in this area.

Pat Buckley (Cork East, Sinn Fein)
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I also stand in solidarity with the section 39 organisations. We cannot afford to lose SouthDoc services in Fermoy and Mitchelstown. We have discussed the lack of rural transport many times in this House. If we lose these services, people will have to go to Mallow, Cork city or all the way to Midleton and we do not have very much public transport.

It is impossible for those without public transport or private cars.

I also wish to raise how the HSE and the board have worked on the AGM. My correspondents said a text message about the AGM was received on 17 September. They had been advised by email on 10 September that it was taking place. No messages were received about motions and no ballot papers were received on the vote on the motions. There has been no explanation whatever to those working in SouthDoc on what has happened. As the previous Deputy noted, the conditions coming from the HSE are that anyone over 60 years or pregnant may not participate in these services. This is public money. It is a vital service being provided by the people who work in the system and want to provide the service but they seem to be stonewalled, blanked and excluded on certain issues. We cannot allow this to happen.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for raising this important issue, which I am taking on behalf of the Minister for Health, Deputy Stephen Donnelly. The Government is aware of the workforce issues facing general practice in Ireland and that Covid-19 has made accessing GP and GP out-of-hours services more difficult. I acknowledge the continued dedication of GPs towards their patients during this unprecedented time.

I can assure the Deputies that efforts continue to develop and maintain GP capacity throughout the country and that progress is being made. As Deputies noted, GP out-of-hours services for Cork and Kerry are provided by SouthDoc, a private organisation with more than 20 health centres located across the two counties. In March, the board of directors of SouthDoc informed the HSE of their decision to implement plans to deal with the serious challenges being posed by the progression of Covid-19. The measures, which became operational on 14 March 2020, were put in place to protect the patients and staff in the out-of-hours setting.

In accordance with public health guidance, patient in-person contact with GPs surgeries and out-of-hours services has been curtailed as much as possible to help prevent the spread of the virus. Medical advice is provided over the phone where appropriate, and only patients who are clinically assessed as requiring a face-to-face consultation with a doctor are referred for an appointment.

Further to this, the board of directors of SouthDoc made the decision to close a number of health centres. In recognition of the impact of Covid-19 on general practice and to ensure that GPs continue to provide essential services, a package of measures to support general practice was introduced from mid-March. Likewise, a grant payment for GP out-of-hours service providers was also introduced from March, to support the continued provision of out-of-hours services.

The HSE has informed me that in the period following the closure of certain service locations, the board of directors and medical directors of SouthDoc have regularly reviewed their contingency service plans, and the closed health centres have been reopened on a phased basis. All centres in Cork city and county, with the exception of Blackpool for north Cork city, have now reopened. The centre in Fermoy was reopened on 10 June.

The HSE is in continued discussions with SouthDoc on how its service will be delivered in the weeks and months ahead and has requested that the reopening of the Blackpool centre be prioritised. SouthDoc has assured the HSE that every possible effort has been made and will continue to be made to avoid or minimise any impact on patients, and has informed the HSE that plans are being prepared for the reinstatement of services at the Blackpool centre, the only centre that remains closed.

There are no plans at present to change the provision of SouthDoc out-of-hours services in Fermoy and Mitchelstown. Any changes to the current service provision in any treatment centre would be subject to discussion with and approval by the HSE Cork-Kerry community healthcare chief officer.

Seán Sherlock (Cork East, Labour)
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I welcome the response insofar as the Minister of State has stated on the Dáil record that, "There are no plans at present to change the provision of SouthDoc out-of-hours services in Fermoy and Mitchelstown." I welcome the fact that any service provision changes would have to be subject to discussion. It seems the Minister of State's response acknowledges that this is a private organisation.

The key point is that there must be transparency about any decision-making procedures where they relate to the diminution of services for a massive geographical area from the Blackwater valley, the Kerry border over to the Waterford border, covering the towns of Mitchelstown and Fermoy and any points in between. GPs have told me this is a proposal to cut off a centre by stealth by imposing guidelines about GPs who may be pregnant or over 60 years. Doing that automatically removes one-third of the capacity of the centre in Fermoy. That is unconscionable and something we must push back against. I welcome the Minister of State's response, but we are holding the Government's feet to the fire on this because it is important that we do not lose the services. I take the Minister of State to be a decent and honourable person and take her at her word, but we will continue to monitor this situation and to support section 39 employees because we want to ensure that we do not lose our GP out-of-hours services, notwithstanding the reduction in capacity.

Pat Buckley (Cork East, Sinn Fein)
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I also welcome the Minister of State's response. It referred to out-of-hours services and concluded by saying, "Any changes to the current service provision in any treatment centre would be subject to discussion with and approval by the HSE Cork-Kerry community healthcare chief officer." That is what I was trying to say - that the communication between the HSE and GPs in SouthDoc does not seem to be there. One person wrote to me to say that if, for example, the other out-of-hours services providers and the HSE adopted such ludicrous measures, the whole system would collapse, but luckily for the people and patients of County Cork, it is only SouthDoc that seems to be doing so.

I welcome the Minister of State telling us that the system will remain open, but the left hand is not seeing what the right hand is doing. The HSE is saying it is implementing things and will cut one-third of the services. It gives the case for why it is not viable. It has a hugely detrimental effect on the whole north Cork area which will spill out to Midleton or to Cork University Hospital or to Mallow. It is not feasible. I will give the Minister of State the information I have and appeal to her to ask the HSE precisely what has happened, where is the breakdown with the board members, and what happened with the board meeting. Why were the GPs not consulted? It is worst for the patients in the area who need the service. They are in fear of what might happen and all they want is clarity that the service will be protected well into the future. We all know that rural areas are losing GPs all the time. It must be sorted out once and for all.

Mary Butler (Waterford, Fianna Fail)
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I thank both Deputies again for raising this really important issue. I know how important this service is in any community, and out-of-hours is especially important. The Government remains committed to ensuring that patients throughout the country continue to have access to GP services. Both Deputies asked why certain GPs were being excluded from the SouthDoc rota. The HSE is aware of that, including the exclusion of more elderly GPs. I think Deputy Buckley also mentioned a pregnant GP. It is understood that this in an attempt to maintain the health of staff more at-risk from Covid-19-----

Seán Sherlock (Cork East, Labour)
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I ask for a bit of latitude. I know of no Irish College of General Practitioners guidelines on the exclusion of GPs from delivering front-line healthcare on the basis of being over the age of 60 years or pregnant. I would caution the Minister of State not to use that line with us, please. I would also caution against the use of the word elderly in characterising certain GPs.

Mary Butler (Waterford, Fianna Fail)
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As Minister of State with responsibility for older people, I would never offend any of our older people. If the Deputy gives me a chance to finish, he might not find it necessary to interrupt me.

5 o’clock

It is understood that this is an attempt to maintain the health of staff who are more at risk of Covid-19. However, as a private organisation, the rostering of GPs is entirely an operational matter for SouthDoc. Neither I nor the HSE has any role in this regard. I reiterate that the HSE has advised that there are no plans to change the provision of SouthDoc out-of-hours services in Fermoy and Mitchelstown.