Conor McGuinness (Waterford, Sinn Fein)
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71. To ask the Minister for Health her views on the worry and deep frustration of families and individuals in County Waterford and across rural Ireland about the shortage of GPs and the consequent difficulties being experienced by many patients accessing timely GP care, especially in rural communities. [10113/25]

Conor McGuinness (Waterford, Sinn Fein)
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What are the Minister's views on the worry and deep frustration of families and individuals in County Waterford, and rural Ireland more generally, about the shortage of GPs, and the consequent difficulties experienced by many patients in accessing timely GP care, the distance they have to travel to access it, the delays in accessing it and the impact on their health and well-being?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I certainly understand the frustration and worry that comes with having difficulty in accessing GP services. That is not what we want. Timely and available access to GP services is critical to good healthcare. In rural and remote areas, in particular, general practice is often in a role of clinical leadership for patients for whom access to other services is farther away.

Being aware of this, and that the country as a whole needs more GPs, the Government has taken a series of measures in recent years - and is committed to continuing them - to increase the number of GPs. Significant investment in general practice has been made under the 2019 and 2023 GP agreements, which provide for increased fees and supports for GPs, including specific supports for rural practices, making general practice in Ireland as a career more attractive, I hope. The agreements also provide for new services for patients, including the GP chronic disease management programme, which is having a transformative effect on patient care. In addition, recruitment of GPs from abroad is ongoing under the international medical graduate, IMG, rural GP programme, with 114 IMG GPs in practice as of October last. Placement of GPs under that programme is targeted at underserved and, in particular, rural areas. Most important for the future, the number of GP training places available has been increased from 202 in 2019 to 350 last year, and that will feed through to an increased number of GPs graduating and entering practice.

I welcome the initiative of the University of Galway to develop medical and pharmacy education with a focus on the differences and additional challenges of delivering services in rural areas. It is appropriate and important that people are being attracted into that from an early stage.

The continued use of increased GP training places and GP recruitment under the international GP programme is committed to under the programme for Government, which also - I think we will come back to this - recognises the potential for using HSE-employed GPs in a variety of locations.

Conor McGuinness (Waterford, Sinn Fein)
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These measures are not being felt in the communities I represent in towns and villages from Tallow to Dunmore East, Portlaw, Dungarvan, Lismore, Cappoquin and Kilmacthomas. Capacity is not keeping pace with demand for GP services. Retirement, as I know the Minister is aware, creates difficulties and has created particular difficulties in west Waterford for people accessing GP services. The Irish College of General Practitioners said late last year that 25% of GPs currently working are aged 60 or over, so this problem will only get worse. There are significant barriers to young GPs entering practice, particularly in rural Ireland. They need to be faced down.

I put a parliamentary question to the Minister a number of weeks ago. The hands-off approach of the Department to, in particular, guaranteeing GP services to non-medical card holders, leaves an awful lot to be desired in rural communities including in my county, Waterford.

David Cullinane (Waterford, Sinn Fein)
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I echo the points made by my colleague. I visited with him a GP centre in Tallow, County Waterford. It has an application in for funding because the practice is too small and the space in the centre is not fit for purpose. We could see that ourselves when we visited. There is a need to progress funding for it. The same is true of the Cappoquin health centre. I got a phone call from the lead GP there last week. It was accepted as a GP training surgery. It has three young GPs. They have an application for funding in and they are telling me that application is not progressing as quickly as possible. These are two GP surgeries in rural towns with multiple GPs working from them contacting us as public representatives and asking us to intervene because they believe their funding applications are not progressing as quickly as possible. Will the Minister look at both of those and make sure they are expedited as much as possible?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I always thank Deputies for raising practical problems and barriers I can interrogate and investigate within the Department and HSE. I do not know the status of every application so I really appreciate it. I am informed by the Minister of State, Deputy Butler, who also serves the community in Waterford, that she met HSE Estates last week on the Tallow project, which is important. She will be keeping a close eye on the progression of that. She also informs me Tallow GP service now has four GPs operating. It is a small rural town and it needs the GP services but this is a welcome development and we will continue to work with HSE Estates.

The locum situation in Lismore has been resolved, with a permanent GP now in place, as is appropriate. The Department is working with several practices in west Waterford on their premises. There are plans for a new primary care centre in Lismore. We always want to hear about-----

David Cullinane (Waterford, Sinn Fein)
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Will the Minister have a look at the one in Cappoquin?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will indeed.

David Cullinane (Waterford, Sinn Fein)
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It is over a year since we visited Lismore, so it is urgent.

Conor McGuinness (Waterford, Sinn Fein)
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To pick up on what my colleague, Deputy Cullinane, said about Cappoquin, this is a case in point. We are trying to get GPs into rural communities. This GP practice is seeking to become a training centre for GPs. Because of the delays with this, it is unable to do that. That is creating downstream issues.

Dungarvan lost a GP to retirement a number of years ago. I, the Minister of State, Deputy Butler, and others worked very hard to get appropriate care for many of that GP's patients. Many of them have been forced to travel significant distances, including people who are ill, older or infirm. We need to grapple with that. How can we ensure there are GPs not just in our small towns and villages but also in larger towns so people can access GP care where they live? Key to that will be elements of Deputy Cullinane's landmark policy proposal published last year. Directly employing GPs within the health service is an important aspect.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I have not seen that for some time. It is welcome to see it.

David Cullinane (Waterford, Sinn Fein)
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It has not gone away.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Government was making the same case during the election and continues to make the case for employing GPs through the HSE. It does not matter where an idea comes from. Let us just do it.

Deputy McGuinness referenced barriers in his earlier intervention and I did not answer him.

To be fair, the Government has tried to place a particular focus on rural supports. The 2023 contract is an example. Practices in receipt of rural supports receive the maximum rate of practice staff subsidies in a significant effort to reduce staff costs for those who will establish their own practice. They also receive the maximum rate for locum supports for leave taking. On new GPs, the Deputy is right that when a retirement happens it is very disruptive. As I said, the GP training scheme increased by 80% from 2019 to 2024 with 350 new training places and 346 new entrants commencing training last year, an increase of 21% on the previous year's intake of 286. The very crude replacement rate is estimated at a rate of one to three GP graduates taken on board for every GP retirement and we have that particular focus on rural GP training.