Dáil debates
Tuesday, 4 July 2023
Saincheisteanna Tráthúla - Topical Issue Debate
General Practitioner Services
11:20 pm
Christopher O'Sullivan (Cork South West, Fianna Fail)
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I am not sure how familiar the Minister of State is with west Cork.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Very.
Christopher O'Sullivan (Cork South West, Fianna Fail)
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That is very good. I would usually be trying to sell the place to her. I would tell everyone how great the place is and would say that it has everything, yet, unfortunately, the one thing it lacks is an abundance of GPs. That is why I am raising this Topical Issue.
The Minister of State is familiar with the area. It is a vast area and it is geographically unique. In many places, there will be one GP and one GP practice, maybe with a couple of practice nurses, covering a vast area. This is the problem. It is putting services under pressure and it means in many instances that families and other people living in the area and even visitors are struggling to access GP services. This pressure that is being put on GPs is also putting the really important out-of-hours South Doc services at risk. It has become so bad that GPs are getting to the situation where they are unable to just take a week’s holiday, which is very sad. It is not good enough for the GP. It is also not good enough for the service users and the people living in that area. That has to change.
Unfortunately, the situation has disimproved over the past number of years. I would like to mention the GP for the Beara Peninsula, which is the furthest west tip of west Cork. She is based in Castletownbere, which is the town that is relevant to that area. The GP is unbelievable. She is so dedicated to her work, to the people of the Beara Peninsula and to the patients who she serves. She rarely takes lunch.
She never gets home when she is supposed to get home and she is unbelievably dedicated to what she does. She was in a position to take a week's holidays with her family, which is an important thing for her and her family to do. However, for the retired GP who had offered to cover for her during this week, her medical insurance ran out the day before she was due to start providing cover for the GP in the area. The insurance could not be renewed, which is ridiculous. This meant that this GP, who has dedicated her life to serving the people of Castletownbere had to make the heartbreaking decision of closing her practice temporarily, leaving the people of this vast geographical area on the furthest south-west tip of Ireland without GP cover.
That is not good enough but unfortunately that scenario I have just painted is the reality on the ground. GP services are under pressure, out-of-hours SouthDoc services are under severe pressure and families moving into the area are failing to get access to a family doctor. Something needs to happen. I understand that 350 training places are being made available in 2024, so I want to know when that is happening and how soon it might be happening. There is also talk of 100 non-EU GPs being recruited to try to ease the pressure. Recruiting 100 GPs will not be anywhere near enough so I would like to see that number increased. When can we expect to see these non-EU GPs recruited?
Then there is this strategic review that we are expecting. We need to see that published as soon as possible so that we can move on, reform and bolster large parts of Ireland with the GP cover that is needed to serve communities. I am looking forward to the Minister of State’s response. I appreciate the Minister for Health is not here but I am sure she will do an incredible job of representing him.
11:30 pm
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy for raising this matter on behalf of his constituents. In recent years, general practice has had to do more as demand for services, life expectancy and the population have increased. The Government has taken a number of measures to improve the recruitment and retention of GPs, and to increase the number of GPs practising in the State. The 2019 GP agreement provides for an additional €211 million in expenditure for general practice, an approximately 40% increase on the funding provided prior to the agreement. The agreement has introduced a €2 million annual fund to support GPs in areas of urban deprivation. Rural practice supports have been increased by 10% under the agreement also.
As was announced this week, agreement has been reached with the Irish Medical Organisation to extend eligibility for GP visit cards to people who earn up to the median household income and to children aged six and seven. Approximately 500,000 additional persons are expected to become eligible for free GP care under this expansion, the largest expansion of access to GP care without charges in the history of the State. That new GP agreement includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP out-of-hours services and a pilot scheme to assist rural GPs to source locum cover for leave. A new form of practice grant will also be made available to GPs for additional support staff, in addition to an increase in the existing practice support subsidy. The total financial package will amount to approximately €130 million in 2024.
The number of GPs entering training has more than doubled, from 120 in 2009 to 258 in 2022, with 285 places available this year. Some 350 training places are planned for next year. The HSE is also working with the Irish College of General Practitioners on a programme, as the Deputy said, to bring 100 non-EU GPs into the country this year. That initiative, which has already commenced, with 25 posts started in January 2023, is planned to extend up to 250 GPs by the end of 2024. The initiative is targeted at rural areas, areas of urban deprivation and those difficult-to-fill posts in various geographical locations across the country.
The terms of reference for a strategic review of general practice have recently been published. That review will commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including GP capacity issues, and I hope it will set out the measures necessary to deliver a more sustainable general practice.
Christopher O'Sullivan (Cork South West, Fianna Fail)
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The Minister of State mentioned the extension of GP visit cards to more than 50% of the population. Approximately 500,000 more people will be eligible for GP visit cards. This is fantastic and it is going to mean that those who most need GP care or assistance will have access to it. It goes a long way to addressing what has been a huge issue within our health service for a long time, namely, affordability. This is reformative and it has to be welcomed on all fronts.
There is always a "but" and this measure will compound the issue I have just outlined to the Minister of State. That is the pressure that rural GPs in particular are under because of the difficulty they have in getting locum cover. It is an exercise in itself for a GP to try to get cover, whether it is through locum services or ringing around to friends or retired doctors. It is a huge effort and it is not really fair. We welcome this measure of the 500,000 extra people getting access to GP visit cards but we need to put measures in place now to bolster these services. GPs in rural areas have been warning of this scenario for a long time. They have been warning many of us that this was going to happen. It is happening and they are under pressure. My message to the Minister of State to bring back to the Minister for Health - and I will bring it to his attention as well - is that measures need to be put in place straight away to ensure the supports are there for GPs, GP practices and practice nurses.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I mention the locum services and the Deputy highlighted the difficulty in getting insurance. I invite him to bring that to me directly as Minister of State with responsibility for insurance. If there is a systemic issue, I will raise it. I will discuss it with Insurance Ireland and try to find a route for it. It seems that getting locums often involves asking people who have retired to help. We are living longer lives and working longer lives. People may wish to do locum or flexible working and it should be easier to get insurance. I am happy to pick that element up with the Department of Health and I ask the Deputy to provide me with more information on that.
It is important to analyse the rate of increase in GPs entering training contracts relative to the rate of increase of population. It is clear that it is a significant expansion relative to 2009 but whether it is going to keep pace and get ahead of pace with the continued population growth, as ahead of profile as you might have expected that to be, is important to analyse. There is an opportunity to bring non-EU GPs in and to benefit from the influx of immigration that we have had into this State, which includes a range of skilled and less skilled people and professional and non-professional people. We must take advantage of the skills they bring to Ireland. To make sure that is well distributed around the country, so that everybody benefits from that, is an important initiative and one which warrants intense focus and scrutiny by the Deputy and every other Deputy in the House.
The number of doctors training to work as GPs in the country has increased significantly in recent years and will continue to do so. However, the question is: how it is analysed versus population growth and the distribution of that? More work needs to be done to improve GP services further and to cater for increased demand. The strategic review of general practice will examine a comprehensive range of issues, including GP capacity services in rural areas, such as west Cork, and identify that change is needed for a better GP service in the future.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the four Deputies for raising these matters and the Minister of State for being here to deal with them.