Tuesday, 19 October 2021
Ceisteanna - Questions - Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
General Practitioner Services
The Minister will be aware that over recent years there has been a growing shortage of GPs, to the point where it can only be described as a crisis. The Irish College of General Practitioners, ICGP, has found that 700 GPs will retire in the next five years. An ICGP poll this month shows that 60% of approximately 900 GPs surveyed were full to capacity or beyond. What precise steps is the Minister taking to address this issue to ensure that we have adequate levels of staff in primary care?
I thank the Deputy for the question. I agree it is imperative that general practice has the capacity we need because we have big ambitions for GP services, particularly as we move to care in the community. In that regard, the number of GPs has increased by about 12% over the past ten years. We need to look at that per capitaas well. The 2019 figures show that we are at 82 GPs per 100,000, which is slightly above the EU average of 80. My view, which I think the Deputy shares, is that we need to go further and use GPs more in terms of community care.
I am very aware that there are workforce issues, including changing demographics, GPs nearing retirement and difficulties filling some of the GMS slots, which can be particularly impactful on local communities. The 2019 agreement with GPs is key in terms of a 40% or €210 million increase in investment in general practice between 2019 and 2023. That is a very big increase. I am happy to say that in spite of the pandemic we are on schedule in terms of the delivery of those resources. Between 2019 and this year, we have seen an increase of approximately €144 million, with an additional €63 million provided in the budget for next year. We are on track in that regard.
The Deputy will be well versed with regard to some of the benefits of the chronic disease management programme and the roll-out in that regard in terms of chronic obstructive pulmonary disease, chronic heart disease, asthma and diabetes services, etc. I acknowledge the incredible work GPs have done to continue to roll that out in the middle of the pandemic. GP access to diagnostics has been increased this year. There are other initiatives as well, which I can come back to in my later reply.
In terms of capitation fees and increased supports for GPs in disadvantaged areas, there is a new fund in place. The question of maternity and paternity supports for GPs has been a real problem, particularly in some of the more rural areas and smaller practices. There have been moves to that end this year as well.
I thank the Minister. I wonder if he is listening to what graduates and trainees are saying because a huge proportion of them intend to emigrate. We do not have to guess at the reasons for that. We know from the regular ICGP survey that issues such as too many clinical sessions, onerous workload, management responsibilities and traditional responsibilities are unattractive. GPs are no longer prepared to work long hours. They want flexibility and better quality of life. Will the Minister accept that there is a problem with the career structure that is on offer now for GPs? Any change in that regard over recent years has been blocked by existing GPs, which is understandable because they have invested in their practices and so on, but that model does not serve the needs of younger GPs. Is the Minister looking at that issue at this point?
The short answer is "Yes". The first thing we needed to do was to provide more GP training posts. The change here is very impressive. In 2009, we had 120 people entering GP training. In 2020, we had 233. Step one has seen a very significant increase in the trainee positions. I take the Deputy's point that there is no point training these amazing people to be GPs only to see them leave the country. I am aware that many trainees are saying that they do not want to work in the old ways, and that they do not want to set up a practice on their own and work on their own. We know that many GPs want to work together and that they are interested in multidisciplinary teams and much more integrated care. One of the challenges we face in terms of some of the rural smaller practices is exactly that younger GPs want to work together. We are making various changes. Is there more that we can and should do? Yes, I believe there is.
The figures mentioned by the Minister are fine but the HSE claims that we need to have 250 training places every year for new GPs. I asked the Minister if he has any proposals with regard to the career structure. References to salaried GPs and the type of flexibility so many new GPs are looking for were seen as a threat to existing GPs. This does not have to be a threat. There is no problem with leaving existing GPs doing the business they way they are doing it, in some cases single-handedly in long-established GP practices in which they have invested and so on. That is all fine. That need not be interfered with, but will the Minister accept that there is a need for a new model for younger GPs who want that flexibility and better quality of life? Many GPs, including female GPs, want to job-share or work part time. They want that type of flexibility. Is the Minister considering salaried GPs? This was offered by his predecessor, but I know it was blocked for union reasons. Would the Minister consider it at this point?
Yes, absolutely, if that is what is required and if that ultimately leads to better care for patients. I do not think we should rule anything out. In terms of the trainees, as I said we are up to 233 this year. Real progress has been made, which is very encouraging. There have been changes. Some of the changes include more flexible GMS contracts, sharing of GMS contracts and GPs allowed to hold GMS contracts for longer, now up to their 72nd birthday. More supports for rural GPs are being rolled out this year, including maternity and paternity leave arrangements, as well as supports for GPs in urban areas such as increased GP access to diagnostics, which has been received very well by GPs.
Ultimately, the question for us all is whether there is an argument for thinking about a new GP contract. We know the old GP contract was put in place 40 years ago, or something like that.