Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State, Deputy Collins, for coming in this evening. I raise the matter of the reconfiguration of the North East Doctor on Call, NEDOC, service that we received correspondence about in June. This is worrying for my constituents as a reconfiguration is due to come into effect from 4 August. In other words, a change to the service will come into effect within a matter of weeks. This essentially means there is going to be a reduction in the service where out-of-hours care on a face-to-face basis will only be provided until 10.30 p.m. at night on weekdays and 10 p.m. at the weekends. I do not need to tell the Minister of State it is often at night-time or the weekend that things happen, accidents happen and people become sick and unwell.

This reconfiguration NEDOC is talking about is therefore of serious concern to my constituents in Cavan-Monaghan. From further reading of the correspondence we received from the service, this is not new news to the HSE. This is something that has been the plight of NEDOC that it has communicated to the HSE for some years. NEDOC has clearly outlined a lack of funding and a serious shortage of doctors as the reasons for this change and reconfiguration. The serious shortage of funding suggest there has been a lack of engagement from the HSE around this that has been ongoing for years. It must be said our doctors and GPs across Cavan-Monaghan have been under severe pressure, as they have been throughout the country. They have reacted and responded to Covid. They have reacted and responded to their patients with great care and compassion and have seen patients as much and as often as they could, despite the challenges Covid presented to them.

Our GPs are already overburdened and under pressure and their capacity is at maximum. To expect the local GPs to provide anything beyond the service at their practice is expecting far too much. We cannot expect them to be on call overnight or over the weekend and then to go in and provide the high-quality service they provide during the day. Up to now I understand locum GPs have been able to fill that gap but that is unsustainable.

I want to read a piece from a two-page letter from NEDOC that ultimately says it all. It states:

To have the support of these highly qualified doctors is essential to the provision of our service. We are constantly engaged in a recruitment programme for qualified doctors and successfully navigated the covid era as doctors became unavailable, however now the medical manpower market is so competitive that it is increasingly difficult to source doctors under the terms and conditions we can offer. In order to attract doctors to Ireland or retain the doctors that have already trained in Ireland, we need to be able to offer better terms and conditions and to do that we need HSE support which is not forthcoming.

I repeat - "is not forthcoming". That is the really disturbing part of all of that.

I am going to conclude because there is another piece to this, namely, I am also receiving correspondence from people who are living in the area who cannot even get a daytime GP service. I want to tell the Minister of State about Paul and Linda Greene. I received a letter from them that would break your heart. They moved to Emyvale from Mullingar at the end of January and are both nearing retirement age. They wrote to me out of absolute frustration because they cannot get a GP in Cavan or Monaghan. It has actually been suggested to them they should perhaps hold on to their GP in Mullingar, which would give them a 240 km round trip. That is farcical. Will the Minister of State give me some idea of how the Minister for Health and his Department are engaging with the HSE to address this issue?

Niall Collins (Limerick County, Fianna Fail)
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I thank the Deputy for raising this important issue. General practice is at the heart of primary care, and a robust general practice and GP out-of-hours service is essential to the delivery of primary care health service. The Government recognises there are capacity challenges facing general practice. However, the Minister for Health's ambition for general practice is to ensure everyone has access to a GP when and where they need it.

Currently, there are 2,551 GPs contracted to provide services under the General Medical Services, GMS, scheme. As of 1 June, there were 33 GMS vacancies in the country, which just over 1% of the total number of GMS panels. There are two vacancies in the Cavan-Monaghan area.

While GP out-of-hours co-operatives are private entities, the HSE provides substantial funding to support all co-operatives and covers a wide range of costs. NEDOC Limited operates under a service level agreement, SLA, with the HSE. The HSE has confirmed there has been no change to the funding arrangement for 2022. This year, NEDOC will receive approximately €917,000 for out-of-hours services. NEDOC is also in receipt of substantial grant funding for medical card patients and Covid test referral and assessment.

NEDOC Limited recently informed the HSE of its intention to reconfigure the GP out-of-hours services in the north east with effect from 2 August. The proposals include the withdrawal of overnight doctors in four treatment centres, with the appointment of one central overnight doctor who will manage calls requiring doctor advice by telephone for the four counties. The HSE recently met the chairman and representatives of NEDOC and the company outlined a number of operational and funding concerns. However, the HSE's view is the financial forecast for the company, given the return to almost pre-Covid activity levels, remains viable. The HSE advised NEDOC all operational and funding concerns will be managed by way of a collaborative process using the mechanisms contained within the SLA. Following the meeting, it was agreed the HSE's chief officer of the midlands Louth Meath community health organisation would write formally to the chairman of NEDOC outlining the process for engagement and collaborative working. In this context, the HSE has asked NEDOC to defer the 2 August deadline as the date for introducing any changes to the out-of-hours GP service in the north east.

The Government is aware of the workforce issues currently facing general practice and has implemented a number of measures to address this. These measures include an increase in investment in general practice by approximately 40%, or €210 million, between 2019 and 2023 under the terms of the 2019 GMS GP agreement. The agreement provides for increased support for GPs working in rural practices and in disadvantaged urban areas and for improvements to maternity and paternity leave arrangements. In addition, the number of GPs entering training has been increased steadily over recent years, rising from 120 in 2009 to 233 in 2021. These measures will see an increase in the number of GPs working in the State and improve access to GP services for patients throughout the country.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I thank the Minister of State. This issue is so critical that GPs in the Carrickmacross area got together and penned their own letter of concern to suggest the town needs more GPs to provide the service that is needed due to the increasing age demographic and the cultural diversity of the population. When GPs are coming together and putting pen to paper like that, it backs up what NEDOC is saying because one cannot survive without the other. Will the Minister of State ask the Minister to ensure the HSE fully engages with Dr. Séamus McMenamin on this issue of acute doctor shortages and the underfunding by the HSE.

I came to this debate with a solution as well and not expecting that that would not be the appropriate approach to take. One arm of my solution is to extend Monaghan minor injuries unit and its operation to a 24-7 basis.

That is not currently the situation. It is a five-day service. The Minister visited the hospital when we were in opposition and he felt the enthusiasm and willingness of the staff within the minor injuries unit to extend the service. That could be a help to NEDOC. It could be a help to the lack of GPs on the ground. More important, it would be a significant help to the constituents of Cavan-Monaghan who use the minor injuries unit. It is a large service that is expanding all the time but we need the length of service to extend, along with the variety of services provided. We need it to go to a 24-7 basis.

I compliment Councillor Seamus Coyle of Monaghan County Council who raised this matter and had a motion passed unanimously asking that of the RCSI group.

I ask the Minister of State's Department and the Department of Health to engage with Dr. Ian Carter, the top man in the RCSI group, and ask him to accede to this request to run the minor injuries clinic on a 24-7 basis.

Niall Collins (Limerick County, Fianna Fail)
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I thank the Deputy. Her requests are noted and will be transmitted to the Minister for Health and the HSE. I assure her that the Government remains committed to ensuring that patients throughout the country continue to receive adequate access to GP services and particularly to out-of-hours services.

We know we could do with more GPs. We all face that fact in our constituencies. The preliminary census numbers have been published and show an increase in our population to 5.1 million. That is another factor causing the pressure that our GP services are experiencing due to the increased numbers of people who are seeking access. The census data also tells us that people are living longer. The rate of births has exceeded the rate of deaths. People are living longer, thankfully, which is a credit to our health services. There are also a lot of migrants coming to the country. The Deputy has alluded to the migrant community within her own constituency. It is important that we continue to resource our GP services.

The Department of Further and Higher Education, Research, Innovation and Science has engaged with the universities to create more places in high-demand courses, including medicine. We need to produce more doctors. That is what we are doing at our level.

The Government is committed to improving the whole primary care setting. There is significant investment in primary care centres, as the Deputy will be aware. They are being built in all parts of the country, including in her constituency. As I alluded to earlier, the numbers of entrants into GP training went from 120 in 2009 to 233 in 2021. Some 238 places for GPs to train are available this year. We are doing a lot in that space that will go to help alleviate the problems. The Deputy's message will be conveyed to the Minister for Health.