David Cullinane (Waterford, Sinn Fein)
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75. To ask the Minister for Health if he will outline his strategy for addressing the collapse of general practice and primary care out-of-hours services; and if he will make a statement on the matter. [52298/22]

David Cullinane (Waterford, Sinn Fein)
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We have a crisis in general practice. We have had reports in recent days of GPs and trainees seeking to emigrate. They are seeking to leave this State because they do not feel they will have opportunities here. The Minister will be aware that while I support the extension of free GP care, some concerns have been expressed by representative bodies about the capacity. We know out-of-hours GP services are not what they should be. What is the Minister's plan for general practice in the coming months and the coming years to build up that capacity?

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for raising the issue. Like him, I recognise that there are challenges facing general practice in terms of capacity, including out-of-hours services, and importantly therefore for the people who matter in all of this, which is their patients and the communities they serve. Historically, out-of-hours services have been something that GPs have provided. We know that more and more GPs are now opting out of that provision and are looking to the State to provide it, for reasonable reasons relating to work-life balance and so forth, but it does create a very significant additional task for the State to provide services where in the past GPs might have provided it.

I would love to hear more balance, not from the Oireachtas on this but from the representative bodies. The GPs and their representative groups quite rightly demand new capacity and we are providing that. I would like to hear more, perhaps debates like this help, about the capacity that has already been added. For example, since 2019, three years ago, baseline funding for general practice has increased by more than €211 million, approximately 40%. As Deputy Cullinane will be aware, the budget for next year will provide significant additional funding for general practice in terms of extra capacity. I want to see a big expansion in the roles of practice nurses. There is much more we can do in terms of patients being supported and seen directly by practice nurses and in administrative supports and IT supports.

The roll-out of enhanced community care and direct access to diagnostics has been very well received by GPs this year. We estimate approximately 200,000 scans will have been referred directly by GPs themselves. We provided funding of €25 million last year, €35 million this year and €45 million for next year. I will continue with the responses.

David Cullinane (Waterford, Sinn Fein)
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Obviously, I welcome any additional funding that goes into general practice, but I have also engaged with the representative bodies in recent years, in particular in recent weeks and months since the Government's announcement. There are solutions. What GPs say to me is that we need to train more GPs and we need to increase the number of training places. I agree about practice nurses and that we need protected funding for training in order that we can have a better skills mix within general practice. We must also provide practice nurses with the option to become specialist nurses. We must consider employing GPs directly to provide out-of-hours locum support, but also to provide the out-of-hours services that GPs are perhaps not covering. We should have a blended mix of independent GP practices and directly salaried GPs who can do some of that work, but we also need a new, modern, fit-for-purpose contract. The contract itself is quite archaic in terms of the staffing subsidy. There is a lot that can be done. If that is done, and we put the infrastructure in place, then we can expand free GP care. There is a fear that if we try to go too quickly and the infrastructure is not there what we will end up with are waiting lists for GPs, which I am sure the Minister does not want, I do not want and patients do not want.

Stephen Donnelly (Wicklow, Fianna Fail)
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I am very open to the idea of the HSE directly employing GPs. It is something we should pursue. We know there are some areas in particular that are affected, such as rural areas. For example, I am involved at the moment with an issue in certain parts of Galway concerning out-of-hours GP coverage. There is a role for directly employed GPs in some urban areas, in particular areas that are less well-off where the GPs are struggling.

There has been a significant expansion of training places. In 2010, there were 109 training places. This year, there are nearly 260, and we are on our way up to 350. We can go further. There is room for radical thinking. The Deputy may have heard me say recently that we should probably be looking at doubling the number of college places for healthcare professionals right across the board and increasing the training places to support the placements for the college places.

David Cullinane (Waterford, Sinn Fein)
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Saying it and doing it are two different things. Unfortunately, right across the healthcare system we have not seen the ratcheting up of training places that we need. In Sinn Féin's alternative budget I set out what we would have done this year, namely, 1,500 additional graduate and undergraduate positions across all the fields of study and increased GP training. Having a workforce planning strategy is very important and increasing training places is central to it. That must be done. When the Minister talks about increasing GP training, if he listens to GPs, which I am sure he does, many of them coming out of training places are opting to emigrate. Perhaps the reason is that independent practice is not for them, which is why we should offer the option of salaried GPs in the public system and provide the necessary out-of-hours GPs. As the Minister will appreciate and understand, that in turn will take pressure off acute hospitals and emergency departments. We have far too many people attending emergency departments who should be cared for elsewhere. Some of them simply cannot get access to out-of-hours GP services and end up in accident and emergency.

There are lots of things that we can do. What we need is a new contract in the first instance that is fit for purpose. The Minister must look at the staffing subsidies and increasing the training places. Once we see the infrastructure build up then we must, aggressively and robustly, roll out free GP care. That is what I want to see. I am very fearful that if we do not do that, we could end up with waiting lists for GPs and longer wait times, which nobody wants to see.

Stephen Donnelly (Wicklow, Fianna Fail)
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We are in agreement that we need more GPs. It is relevant that the number of places for GPs has more than doubled in the past decade and we are continuing to increase it. That is going to go some of the way. In part, that will provide more GPs and more cover, which is needed and, in part, it will allow for a different work-life balance for GPs. What younger GPs say to me is that in the past, in their parents' generation, GPs sometimes worked 60, 70 and 80 hours a week. They covered on-call and if somebody got sick in their community, they went out on Sunday night. GPs coming in now say they do not want that. In a lot of cases, they do not want to work on their own. They want to be part of multidisciplinary teams. They want a decent work-life balance. They are dead right. That is exactly what we need to do. We are increasing college places and training places. We are looking at providing rural GP supports.

I also agree that we do need a new GP contract. We are in the middle of several negotiations with the Irish Medical Organisation, IMO, at the moment. We are talking about non-consultant hospital doctors, NCHDs, the new consultant contract and many other issues. There have been some good additions to the GP contract such as chronic disease management and so forth. I agree that when we can find a bit of clear space, which will be soon, we can sit down with the IMO and start looking at a modern fit-for-purpose GP contract.