Pa Daly (Kerry, Sinn Fein)
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I thank the Ceann Comhairle for giving me the time, at short notice, to get in on this important issue. There is a fundamental problem with GP care around the State, and particularly in Kerry, although this is not necessarily related to a Kerry issue. We have had our own problems in Kerry finding doctors for towns and villages like Ballyduff, around the Ring of Kerry and a few years ago in Milltown. Essentially, GP care is privatised and many GPs and the HSE have to settle terms to provide care in communities.

From time to time, the old Tralee Town Council instituted a scheme to help emigrants, Irish people who had been England for 30 or 40 years, to return home. It was in dealing with the Safe Home group, which is based in Mayo, that this difficulty came to pass. Many of these people sent remittances home. When times were very difficult in Ireland, they kept the country afloat and it is very important that we take care of them. One such individual contacted us, and the organisation Safe Home had received an email saying that at the moment, they could only advise that they should keep contacting GPs in the area because the HSE no longer assigns GPs to clients. The email said that for any further queries, an 0818 number could be contacted. For years, it was standard practice that if you had tried and was refused by three GPs in an area, the HSE would then step in, help you out and try to find a GP. This is very important for people in general but more so for Irish emigrants who are coming home. They may have been living in council or trust accommodation in Britain and are coming home. They may have a place arranged here but they need a medical card. One needs a medical card, as the Minister of State, Deputy Butler, knows, for carer's allowance, housing adaptation grants, the HMD1 housing form, or for people with additional needs. A GP and a medical card are needed to understand that and to get into the system, so to speak.

I know that many GPs are under pressure as I have seen in my own county, and no doubt the Minister of State has seen it in hers. However, there is a serious problem. The Sláintecare recommendations have not been implemented. Obviously GPs are under pressure but the HSE is in charge of this whole policy, and really it should be stepping in. Vulnerable people who are returning home after many years abroad should be looked after. It is morally right, and it really should be encased in legality. Will the Minister of State be able to do something about it to ensure that this is not going to happen to any more vulnerable people?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this issue, which is a matter of major concern to the individuals involved. Patient choice of doctor has been, and continues to be, a bedrock principle of the general medical services, GMS scheme. For the vast majority of individuals, their choice of doctor is accommodated and they are registered on the GMS panel of their doctor of choice. In 2022, which was the last full year of data available, out of a total of about 348,000 individuals who were approved for either a GP visit card or a medical card, 3,927 individuals were unable to secure placement with their doctor of choice, or 1.1% of the total. In addition, 3,701 existing GMS patients were reassigned following a change in their place of residence.

While recognising the difficulties this can pose for individual patients, it is fair to say that the extent of the challenge is relatively small in the overall scale of the GMS service provision. However, I acknowledge and accept that for that small amount of people who are finding it difficult, it is very challenging. For those individuals who are unable to locate a GP, a long-standing process is in place in line with the contractual arrangements, whereby individuals are enabled to access GMS services from alternative GPs, either by agreement with individual doctors or through the patient assignment process. In line with these arrangements the HSE may assign an eligible person to be included on a medical practitioner's GMS list.

It is important to confirm that this process whereby the HSE can, under the provisions of the contract, assign patients to GPs remains in place. However, in the period between 1 July to date - this is what Deputy Daly is referring to, that is July, August and September - the HSE was obliged to exercise caution around the application of assignments, dealing principally with urgent and priority cases in advance of the new arrangements that are now being implemented following the agreement with the Irish Medical Organisation, IMO reached last June.

In the context of the learnings from the operation of the existing arrangements, and having regard to the implementation of the extension of eligibility of GP visit cards to include under-8s and those on no more than the median income, it was agreed with the IMO as part of the GP agreement for 2023 to flex the existing arrangements with a view to ensuring an equitable and fair distribution of patient assignments to individual GPs and across geographies, for example, not putting 30 with one and one with another.

In addition to the foregoing, a joint HSE and IMO working group is being established to review the operation of the patient assignment protocol to ensure that it is framed and operating in a fair, equitable, patient- and GP-centred manner and that due regard is given to health and safety considerations regarding GP practice teams, as well as impact on patients in terms of how it is being operationalised.

In response, there has been an issue in the last three months but now it is being resolved in such a way that it is fair and equitable for patients. It will be interesting to see how it will work out going forward. I am aware of some of these cases as well, which came through my own constituency office and I know exactly what the Deputy is talking about regarding people who might have relocated from another country.

Pa Daly (Kerry, Sinn Fein)
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I thank the Minister of State for her response. This is something that came to the attention of Safe Home Ireland on 15 September. I am not sure what arrangements have been in place since the end of June or the beginning of July but this is a category of people who are the most vulnerable and who are returning after many years abroad. Irish citizens cannot get a GP card. How is that fair or equitable for people who were forced to emigrate in the 1960s and 1970s? They spent their working lives abroad and now want to come home to spend their final years in Ireland.

It sounded to me that what the Minister of State said in her response about flexible arrangements with the IMO was leaving someone off the hook. I am not sure if it is the IMO or the HSE. These are cases that should be prioritised. There are recommendations in Sláintecare about directly employing GPs. Perhaps alternative arrangements need to be considered because clearly it is not working. It is not working for someone who is most vulnerable and in the latter years of his life. He might have expected a welcome home but he is not getting that. He will be unable to access a whole load of other arrangements. I can give the Minister of State the details of this organisation and the individual concerned. Perhaps something could be looked at for him. Going forward, a policy must be put in place whereby people who qualify have a right to GP care. Any other way is unacceptable.

Mary Butler (Waterford, Fianna Fail)
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I probably should have read the concluding statement first because it contains better news. I again thank the Deputy for raising the issue. I appreciate the concern and the issues he has raised, with which I am familiar. While some persons may have been advised recently that the primary care reimbursement service, PCRS, would no longer assign any medical cardholders or GP visit cardholders to a GP or general medical services, GMS, panel, as per the previous practice, following the short period whereby urgent assignments were prioritised in advance of the new assignment arrangements, the HSE has confirmed that the assignment process for cardholders is, as of today, back in place. I thank the Deputy for tabling the question. The GP agreement 2023, which was announced in July, does contain assignment arrangements on the assignment of patients to GP panels. However, these arrangements do not prevent the assignment of patients and rather are there to help ensure equitable distribution of assigned patients to GP panels.

The good news is that as of today, the HSE has confirmed that the assignment process for cardholders is back in place. The second piece of information is that the GP agreement will look at equitable distribution of assigned patients to GP panels, which I think everybody could understand. Further to confirming the continuance of the assignment process, as mentioned, the agreement provides for the establishment of a working group which will review the operation of patient assignment to ensure a fair system that has regard to individual GP practices.

The situation for July, August and September has come to an end as of today. It will be business as usual to assign the 1% of people who may not have a doctor. The GP arrangement panel will look to help ensure equitable distribution across all GPs.