Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this issue, which I am taking on behalf of the Minister for Health. Of course, people can become unwell outside of normal GP practice hours and may require urgent GP care, so it is important they have access to out-of-hours GP services when needed. Accordingly, general practitioners who hold general medical services, GMS, contracts for the provision of services to medical card and GP visit card holders are required under their contract to make suitable arrangements for emergencies outside normal practice hours. More than 2,500 GPs currently hold a GMS contract, and while they are not obliged to practise in GP out-of-hours co-operatives to meet their outside-of-practice hours service requirements, most do so. A robust GP out-of-hours services ensures that, insofar as possible, urgent care needs are met in the community and not in a hospital setting.

The Shannondoc co-operative provides GP out-of-hours services for Limerick, north Tipperary and Clare. As with the other GP out-of-hours co-operatives, Shannondoc is a private organisation. However, the HSE provides significant funding to support out-of-hours co-operative services through service level agreements, with Shannondoc having received almost €5 million in HSE funding in 2022.

The HSE is in regular contact with all out-of-hours service providers to ensure that these services continue to meet the needs of their local communities. The HSE has advised that Shannondoc has fully reinstated all services in line with service levels pre-Covid and that service delivery is in line with the service level agreement in place with the HSE.

Shannondoc has never provided an overnight service from its Thurles treatment centre, which, as the Deputy has said, operates from 6 p.m. to 11 p.m. midweek and from 9 a.m. to 10 p.m. at weekends and on public holidays. Since March 2020, Shannondoc have operated an enhanced model of care with the introduction of mobile doctors, remote doctors and core treatment centre doctors. If a doctor is not present in a regional treatment centre such as the Thurles centre, a mobile doctor, who I hear is based in Nenagh, will be available to patients if required. This model is co-ordinated by dispatchers and nurses. Following triage to identify the immediate needs of the patient, the mobile doctor will attend the patient's preferred treatment centre, where possible, or the patient will be offered an appointment at the nearest available treatment centre. ShannonDoc has confirmed that, where there is increased demand in certain areas, support teams can be deployed from other locations, ensuring services are provided where most needed.

Furthermore, alongside an increase in HSE out-of-hours co-operative funding for next year to meet existing levels of service increases, additional funding of €10 million is being made available under the winter plan to support GP practices and out-of-hours services providers over this busy winter period. The HSE has confirmed that, in the near future, Shannondoc services will operate from the new Thurles community primary care centre. It is expected that services will move to this centre by the end of this year and that the existing level of service will be retained.

That is the script the Minister has provided to me but, in my experience, going from the bridge in Portumna to Thurles takes one hour and 15 minutes if I drive handily and that is not from the end of the Deputy's county. I cannot imagine what it is like for a patient who is waiting for support. What I am hearing is that we have one main cell in the whole of Tipperary. That is not how Westdoc operates. There are a number of cells, a number of cars and a number of GPs covering the roster. A red-eye shift is provided but there is also weekend cover. I suggest that the Deputy meet with the HSE in his locality and with Shannondoc to see how business cases could be submitted in future to ensure that all cells in his county are covered.

Anne Rabbitte (Galway East, Fianna Fail)
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I will conclude with the script. The Government recognises the need for a strong out-of-hours GP service, a key component in the delivery of primary care services. The Government continues to support GPs and out-of-hours providers in their continued provision of GP services. The HSE provides substantial funding to GP out-of-hours co-operatives to help enable them to fulfil their service commitments and care for their patients. This year, almost €5 million in funding has been allocated to Shannondoc through a service level agreement with the HSE's mid-west community healthcare organisation. The HSE has confirmed that Shannondoc has fully reinstated services to their pre-Covid levels. Under the Shannondoc enhanced model of care, where a doctor is not present in a regional treatment centre such as the Thurles centre, a mobile doctor will be available to the patients. Again, from what I have heard, that mobile doctor is based in Nenagh. Shannondoc services will soon operate from the new primary care centre in Thurles.

From my experience of having recently negotiated a new GP out-of-hours cell for the Ballinasloe area with Westdoc, I know that the nurse support is absolutely fantastic. However, despite all this triage, in eight out of ten cases the patient will still have to see a GP. While the nurse will triage, there is still a requirement to see a GP. It is not enough to have only one GP covering out-of-hours services for the entirety of Tipperary. In Galway alone, we have eight cells. It does not seem adequate for Tipperary to be operating with only one.