Marie Sherlock (Dublin Central, Labour)
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65. To ask the Minister for Health the actions taken by her Department to ensure the continued existence of a practice (details supplied) in Dublin 1 which is currently facing closure due to provisions introduced in the Finance (No. 2) Act 2003 amending section 1008A of the Taxes Consolidation Act 1997; her plans to support the existence of medical charities operating GP practices in socially disadvantaged areas; and if she will make a statement on the matter. [10130/25]

Marie Sherlock (Dublin Central, Labour)
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Last week, I raised with the Minister the issue of the GP Care For All practice in Summerhill, Dublin 1. In the Visitors Gallery today, we have the chair and the practice manager of that GP practice. It is a very serious situation because, by June of this year, this practice will be facing closure unless there is direct intervention by both the Department of Health and the Department of Finance. In particular, I want to ask about the plans of the Department of Health for the continued existence of medical charities in providing GP practices across the country.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Following the Deputy’s question last week, and prior to that, my Department and the HSE have had extensive engagement with the organisation concerned. That engagement has focused on identifying ways the organisation can continue to deliver services, which is what we want, how it can be supported by the Department and the HSE, notwithstanding the tax treatment, and finding what other solutions are possible. Several solutions in line with tax legislation and the provisions of the Health Act have been developed and presented to the organisation concerned, which might have the opportunity to reflect on that. Those solutions identify different business models that are practical and implementable and my Department is confident they would allow the organisation to continue its operation in line with all relevant legislation and the GMS contract. We both want the service to continue.

In addition, the HSE provided for a third party to independently advise the organisation on the matter. I understand that this advice built on the solutions presented and further developed the organisation's understanding of what implementation of those solutions would involve, including the identification of any additional costs and resources required. The Department and the HSE remain committed to engagement to ensure it can continue to provide services. That engagement includes working with it to implement the developed solutions and identify any additional supports recognising patient need in that community.

Issues relating to tax administration are a matter for the Minister for Finance but I am aware that section 1008A of the Finance Act allows, under certain circumstances, for the GMS income of GPs in medical partnerships to be treated as that of the partnership for income tax purposes rather than income of the individual GP. The introduction of this section did not change how GMS income of GPs who are not in medical partnerships, such as those in the organisation concerned, should be treated under tax law. Tax treatment is a matter for the Minister for Finance. What I am trying to do is ensure that this service remains open, that it has concrete solutions that are implementable and that it gets the resource support it needs to provide the patient care I know the Deputy wants for her constituents.

Marie Sherlock (Dublin Central, Labour)
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I wish to put on record that three options were offered to GP Care For All, none of which are operable. Option one was the partnership model, which is simply not viable because of the risk GPs would have to take on. Almost 97% or 98% of this practice is GMS-reliant. The second option, which was the hybrid model, and the third option, which was direct subsidy, were not acceptable to the HSE. The options put forward by the Department of Health are not workable and the HSE has paid for Western Urgent Care to come up with proposals to send to the Department of Finance and we have heard nothing back. The onus is on the Department of Health to ensure that the Department of Finance actually acts to ensure that medical charities can continue providing these services because nobody else is providing these services in some of the most disadvantaged areas in the country.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Deputy set out the different options that were proposed. They were proposed in good faith with a view to keeping the service open and working. At some point, there is a finite number of options that can be proposed and try to be supported. They are really trying to work to find a solution. The Department and the HSE are ready to continue to engage with the charity regarding the proposed structural solutions. It will require some adjustment as to how GP Care For All operates or is structured but the HSE has also made a commitment to cover any funding shortfall arising from a change in the charity's operating model and to work through the implementation of the viable solutions that can be developed. More broadly, I am concerned to ensure that north-east inner-city Dublin is well served and better served by GP services. It is an area that needs GP services and support, as the Deputy and I discussed previously. We are very committed to trying to keep this service open but it will require some adjustment on both sides and we are working to find a solution. The current model will have to change a bit and be flexible in that way.

Marie Sherlock (Dublin Central, Labour)
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I do not doubt the goodwill there is regarding ensuring GP services, particularly to the 2,600 people on the list in GP Care For All, continue but the reality is that the HSE funding is only for the 2024 liabilities, nothing is in place for 2025 liabilities and I am not hearing any solution. We have a private system of GP care in this country with the result that we have significant gaps across this country in some of the most socially deprived areas and this Government is not coming forward with any solution as to how we put in place GP care in those communities. The medical charity model was a solution to the problem but now, it is being upended and facing closure because of those changes in the Finance Act. I am asking the Minister to make sure that this medical charity can survive and that other ones can be set up across the country.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not accept that no solution has been attempted. I know it is not quite what Deputy Sherlock is saying but for the benefit of the House, proposals have been presented to GP Care For All. One is a partnership model, which is a traditional model of service delivery within general practice and also works in other areas. Another proposal is a hybrid model where the HSE contracts individual GPs to provide services to specific patients and a model around that. Another proposal is a more direct subsidy model. A few different options have been on the table. I appreciate that we have 29 seconds to work out the details and I do not wish to read it all into the record of the House but I am certainly happy to try to understand why not one of these models can work. I am also interested to see what flexibility GP Care For All can facilitate as well. The offer here involves structural solutions not just from the Department and the HSE but with an independent third party to try to find a solution, offer of additional resources and offer of direct subsidy. I am certainly not saying, "How much more can we offer?" but I do want to know what we can do to get this resolved because that is our intention. It cannot be that only one side is trying to work it out, however. There must be a certain measure of flexibility.