Michael Lowry (Tipperary, Independent)
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A thriving town centre general practice in Templemore is closing as the HSE has failed to appoint a replacement for the retiring doctor. The proposed closure of this practice, which has 800 patients, is causing distress, fear and inconvenience. Patient-doctor relationships are built on trust and confidence. The family doctor ethos is cherished and respected by every family in Templemore and the district. Medical card patients in Templemore are being transferred to the only other GP practice in the town. Private patients have been left to source their own future medical care. In Templemore, the GP in question made his intentions known to the HSE last February. The HSE recruitment campaign has failed dismally to attract interest from doctors. The people of Templemore are angry and feel let down by the HSE. I give way to my colleagues.

Jackie Cahill (Tipperary, Fianna Fail)
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I thank the Minister and Leas-Cheann Comhairle for taking this Topical Issue matter this evening. We were at a protest in Templemore last Saturday. We have been contacted by numerous constituents in the area who are extremely concerned about the general practice of Dr. Hennessy not being filled by the HSE. Dr. Hennessy had a significant practice over many years and he served the locality well. The HSE failed and it has not tried hard enough. My request to the Minister tonight is for the HSE to provide an extension of six months to the practice in the town to allow ample time to get a replacement. This is for both public and private patients. If public patients are taken on by the other practice in the town, that practice will be overrun with patients. We have seen mergers of practices in other areas of our county where the level of service to patients is not up to the standard required. The earnest request I make of the Minister this evening is for a six-month extension for Dr. Hennessy's practice in Templemore to allow the HSE ample time to get a replacement.

Martin Browne (Tipperary, Sinn Fein)
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I echo the words of Deputies Lowry and Cahill. The people of Templemore are angry that the HSE seems to be ignoring them for some reason. Some 700 patients are being transferred from one practice to another that is already at capacity. This will lead to trouble and is just not good enough. I know from other Deputies and the people of Templemore that the HSE has not communicated what is going on to the people of the town. We all know there are problems with getting locums or replacements but the HSE is talking about no longer providing locum GP cover from 21 October. There is significant worry in the community. As with the other Deputies, I seek an extension and ask the HSE to push to replace Dr. Hennessy. We realise Dr. Hennessy is at retirement age.

Mary Butler (Waterford, Fianna Fail)
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I am taking this Topical Issue matter for the Minister, Deputy Donnelly. I thank all three Deputies for raising the issue of the impending closure of a general practice in Templemore following the recent retirement of Dr. Joe Hennessy. The Government is committed to ensuring that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas in the future. It is imperative that general practice remains an attractive career option for newly-qualified GPs and that services are provided in a way which is accessible to all patients.

The Government is aware of workforce issues facing general practice, including the influence of demographic factors. In recent years, it has implemented a number of measures to improve recruitment and retention in general practice. These measures include increasing investment in general practice by approximately 40%, to €210 million, between 2019 and 2023 under the terms of the 2019 general medical service and general practice agreement. The agreement provides for increased support for GPs working in rural practices and for those in disadvantaged urban areas, and for improvements to maternity and paternity leave arrangements. In addition, the number of GP training places increased from 120 in 2009 to 233 in 2021, an increase of 94% over the 12-year period in question. The intention is to continue to achieve annual increases in the number of training places available. These measures will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.

Regarding the GP vacancy in Templemore, it has not, to date, been possible to source a locum to provide consistent cover for this practice. Since July 2021, eight locum doctors have provided cover, which is not ideal for delivering a quality service and continuity of care for patients. Two recruitment campaigns have been undertaken. The panel was advertised locally, nationally and in the British Medical Journal. In addition, the advertisement was shared with all GMS practices across the mid-west and with the mid-west training scheme in an attempt to attract newly-qualified GPs. Unfortunately, the HSE has not been successful in recruiting a GP to this single-handed general practice in Templemore. It is therefore planned that the group practice in the town of Templemore will take on the panel of patients on an interim basis. An additional GP has been recruited by the practice, which means that three doctors will provide the additional capacity, to provide a safe, accessible and consistent service to the patients in Templemore and the surrounding area. Additional nursing and administrative staff have also been recruited for the practice. This reflects the developing trend in general practice to have larger practices, which can both improve the services available to patients and provide an improved working environment for GPs and their staff.

General medical card scheme patients have been advised of the new arrangements and how to access the new practice.

While the HSE has no responsibility for private patients, private patients have been advised by practice staff of the need to source a new GP. Private patients can contact the group practice, or any other practice of their choice, to request to be taken on as a private patient. Should any private patient find it difficult to source a new GP, he or she can contact the local HSE primary care unit which can support him or her in accessing a GP insofar as it is possible.

Michael Lowry (Tipperary, Independent)
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The scenario in Templemore is being replicated throughout rural Ireland. The entire system must be examined as a matter of urgency. Attracting GPs to sole practices in rural areas has been a problem for a very long time. The problem is growing and will continue to grow. We must lift the excessive restrictions on qualified doctors from countries outside Europe who are willing to practice in Ireland. Incentives must be put in place to make rural practices more attractive to GPs to avert a pending crisis. As far back as 2015, the Irish College of General Practitioners stated that if measures were not introduced to support rural practices, further inequality of access to healthcare among rural populations would result. This warning was ignored. Templemore is just one example of the fall-out from that lack of policy.

Jackie Cahill (Tipperary, Fianna Fail)
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I thank the Minister of State for her answer, but I am not overly happy with it. The reply I received from the HSE stated that Templemore is a rural setting and it was finding it impossible to get a replacement. This is a town that is on the Dublin-Cork railway line and only about five or six miles from the Dublin-Limerick motorway. It has a great educational infrastructure and would be an attractive place for any young GP to begin a practice.

This situation is replicated throughout rural Ireland. The HSE is failing to fill places in practices. The reimbursement of GPs in these areas has to be looked at. An incentive has to be put in place to make young GPs look at rural locations. As I said, Templemore is anything but in the rural hinterland. It is a town that is extremely accessible to every part of the country, with the transport infrastructure it has. When we see a town like this fail to get a GP, it shows why the HSE is failing in other parts of rural Ireland. The merger of GP practices is not working. When practices are merged in other towns in Tipperary, patients do not get the level of service they deserve and expect.

Martin Browne (Tipperary, Sinn Fein)
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I also thank the Minister of State for her reply. The HSE informed me, through a parliamentary question, that it has not been successful in getting a GP for a single-handed practice in Templemore. In that same reply, the HSE all but admitted that it wants to see all GP services delivered through a single clinic. As Deputy Cahill said, a single practice, or everything in one setting, is not working. It is like the closure of St. Brigid's Hospital in Carrick-on-Suir. I have been contacted by people in Cahir about the difficulty they have in accessing GP services in the town, which leads people to go to the accident and emergency department in Clonmel hospital when they cannot get a doctor. That is creating problems for the hospital there. A similar situation is arising in Thurles because a replacement GP in a practice there cannot be sourced by the HSE.

As far as I, and the people I talk to, are concerned, it is another attack on the health services in Tipperary. The HSE needs to get real. As Deputy Lowry said, we need to see GPs from outside the country being brought in to relieve the backlogs.

Mary Butler (Waterford, Fianna Fail)
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I reiterate the Government's commitment to ensuring that patients throughout the country continue to have access to quality GP services. That is what all the Deputies have reiterated tonight. The important role that GPs play in the delivery of our health service and the commitment to providing a responsive and high-quality service to patients is acknowledged. The workload in many GP practices remains quite heavy and the last few years have been particularly challenging.

I also recognise that GPs working in rural and socially disadvantaged areas play a particularly important role. I assure the House that the Government is committed to ensuring that general practices in such areas remain a sustainable and attractive option for doctors. The 2019 agreement on the reform and modernisation of the general medical services contract will be key in supporting and resourcing general practice into the future and making it a more attractive career option for young doctors.

On GP services in Templemore, as I outlined earlier, the HSE has made every effort to fill the vacancy but has been unsuccessful. In order to ensure the continuity of care, and in the best interests of patients, an alternative arrangement has been put in place with an existing group practice in the town of Templemore. This arrangement will ensure local access to GP services for existing patients of the retired GP. However, I will take on board the request that Deputy Cahill initially made about an extension of six months; I will take that back to the Minister. I assure Deputies that the HSE is committed to working with GPs in the area to ensure services can continue to be provided to the local community.