Róisín Shortall (Dublin North West, Social Democrats)
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61. To ask the Minister for Health if his attention has been drawn to a proposal from an organisation (details supplied) to establish a working group on the future of general practice in order to address the serious challenges facing general practice and patient care; if he will undertake to meet with the organisation in this regard; and if he will make a statement on the matter. [8386/22]

Róisín Shortall (Dublin North West, Social Democrats)
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To stick with the issue of the shortage of GPs, we know there are major recruitment and retention problems right across the health service. The Minister described the problems well but we need to talk about what exactly will be done about them. General practice is central to our health service, to its future, to Sláintecare and to the aim of having the right care in the right place at the right time. Will the Minister tell us exactly what steps he will take to deal with the shortage of GPs?

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for raising this issue. We are doing several things. We have to first recognise there is a serious issue. I know the groups met with the Oireachtas Joint Committee on Health and the figures it gave them were very stark in respect of future shortages. Let us all agree this is a major issue that needs to be dealt with. What do we do? We need a very significant increase in training places. As the Deputy referenced in her question, we are setting up a working group on the future of general practice. Under the 2019 agreement, that should have happened either in 2019 or 2020.

I do not want to pre-empt what that working group will come up with. I have various views. A serious gender analysis is required. Certainly, the conversations I have had with GPs suggest the system simply does not work structurally for many women. There are very serious issues with access, especially GMS access. It is more serious in lower income areas where it is a real problem so we need to look at how a future GMS contract interacts with the future of general practice. We moved training to the ICGP. That happened last year and was a very positive move. We are funding roles through the ICGP, for example, the role of women's healthcare in general practice. There is a dedicated resource looking at that issue.

An issue the Deputy has raised many times, where there has not been sufficient progress, is eHealth in the community. Some good things happened during the pandemic, but much more is required in terms of remote monitoring of patients, including practice nurses, GPs, remote sensors and home care workers being able to bring their patients in through the chronic disease management programme.

Róisín Shortall (Dublin North West, Social Democrats)
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The ICGP has done a lot of work in this area. It is great that it is now responsible for training, but the people in that organisation are the ones who provide the policy basis for general practice. They have identified four areas: workforce, workload, IT and data, and bricks and mortar. It is very important that we address all of those. Part and parcel of that is accepting the current business model for general practice works for some people, especially existing GPs, and maybe some in the future, but it does not cater for all GPs.

The important thing is to ask newly qualified GPs why so many of them are leaving this country and going abroad. They have already been asked that in various surveys and it is not about money. Everybody wants a decent income, but GPs do not want to be businesspeople. They want to be doctors practising medicine, they want to work as part of a multidisciplinary team, they want support in their practice and they want a better work-life balance. Does the Minister accept that all those issues are key to ensuring we keep people here after their training?

Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, I do. I accept all those issues. Certainly, the conversations I have had with GPs and members of the Irish Medical Organisation reflect all of that. We need to be flexible. From the conversations I have had with GPs, many of the younger GPs, and some of the more urban-based ones, are very interested in being in primary care centres, multidisciplinary teams and a lot of the innovation around eHealth. Interestingly, some of the older GPs I have spoken to who might be in more rural areas are quite happy with their situation. They want to keep going, but there is flexibility they do not have, such as splitting GMS lists.

The Deputy talked about the business model. There is a real issue with the GMS. GPs say to me that in many cases they lose money on the GMS list. It is income that comes into the practice, but where they make their profit and get to pay their wages is on private patients. If we are moving towards more and more people being able to access GP care for free, that is something we will have to deal with. If we are asking GPs to come into areas, which we must, where the majority of patients are GMS patients, we need to think about that. It cannot be more profitable for GPs to work in well-to-do areas than in lower income areas. That just does not work because lower income areas will not have enough GPs.

Róisín Shortall (Dublin North West, Social Democrats)
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That is the situation at present. That has to change and we have to stop talking about it. We need to move ahead and take action on this. It is understandable that existing GPs who have invested heavily in their practices and premises should be protected, but it does not mean that should be the standard model for everybody.

The Minister needs to introduce that flexibility. That can be done quickly. The contract is very much out of date. We need to start the work to update the contract, but that should not hold up other progress. There is a need for facilitation of GPs to come into primary care centres. Currently, that is not being facilitated because of ridiculous rows about paying rent. We should be bringing in as many GPs as possible. We should also have salaried GPs and contracts where GPs, especially women, can work part time. These are all issues that need to be dealt with quickly. The Minister can deal with them quickly. Will he undertake to meet with the ICGP within the next two to three weeks to discuss its proposals for the working group which will be representative of all stakeholders? Will the Minister please do that? They have plenty of good ideas. They know the issues thoroughly. Will the Minister sit down with the ICGP?

Stephen Donnelly (Wicklow, Fianna Fail)
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I would be delighted to meet the ICGP. It is an excellent organisation. It is doing the training now, but there is an awful lot of innovation and constant thinking about the future of the profession. I agree with regard to the need for salaried GPs. I have no issue with that. I would like to see more of that. It is something of an anomaly in a public health service where the vast majority of GPs are private contractors. That suits many of them and that is fine. Like the Deputy, I have spoken to GPs who would much prefer not to have to be entrepreneurs or businesspeople. They are doctors and they would love to be able to come into the system. There are a lot of primary care centres out there. Many more were added last year. If the Deputy has examples or evidence of situations where the State or the HSE is making it too difficult for them to go in on contract, I would be very happy to take a look at it.

Róisín Shortall (Dublin North West, Social Democrats)
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Will the Minister meet the ICGP within the next two to three weeks?

Stephen Donnelly (Wicklow, Fianna Fail)
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Yes, no problem. I will do so within the next few weeks.

Róisín Shortall (Dublin North West, Social Democrats)
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I thank the Minister.