William Aird (Laois, Fine Gael)
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I draw the Minister of State's attention to an escalating crisis in rural County Laois in the form of the chronic shortage of GPs and the lack of fully developed primary care services. We all accept that primary care is the front line of the health service. It is where early diagnoses happen, chronic conditions are managed and preventative care should take place, easing pressure on our overstretched hospitals. Across rural County Laois, the front line is weakening in communities such as Rathdowney, Mountrath, Ballyroan, Clonaslee, Ballinakill, Stradbally, Graiguecullen and Camross.

The numbers are not good. The Irish Medical Organisation reports that 30% of GPs in County Laois are over aged 60. Many are due to retire within three to five years, but we have no real plan for succession. Nationally, we are facing a shortfall of more than 1,300 GPs by 2027, with rural counties like Laois hit hardest. In towns like Borris-in-Ossory, patients are now told to travel 20 km to 30 km just to see a doctor. This is not sustainable. The crisis impacts many, including older people, families with sick children and people managing long-term conditions such as heart disease and diabetes. The inducement scheme intended to attract GPs to rural areas has clearly failed to fill the gaps. It is not working and we must accept this fact.

The impact of this situation is real and it is impacting real people. I will give the Minister of State a few examples. A rural GP practice in County Laois recently lost its second doctor to retirement. The HSE could not find a permanent replacement. Since then, there has been a reliance on rotating locums, with no continuity of care. I spoke recently with a mother in Durrow. Her son, who has asthma, waited 12 days for an appointment. An elderly woman in Rosenallis, living alone, missed a medication review because she simply could not be seen. These are not isolated incidents. They are daily challenges faced by thousands across rural County Laois. We were told that Sláintecare would bring care into the community, but that is not happening in County Laois.

We have only one operational primary care centre in Portlaoise. In Mountrath, a new centre is supposed to have been finally allocated. I have been trying to establish timelines, but they are vague. Progress is very slow. A location has not been finalised in Rathdowney, despite the clear clinical need, community readiness and commitments given to me in correspondence with the Minister that it would have been done months ago. Meanwhile in Stradbally, services remain minimal and overstretched. Other key services such as physiotherapy, speech and language therapy and mental health services have wait times of more than 12 months. The Minister of State will be aware of that.

I call on her to launch a targeted GP recruitment and retention plan for Laois, including proper relocation supports, administrative assistance and access to the rural pool locally; fast-track the development of the Mountrath primary care centre and immediately finalise, once and for all, a site in Rathdowney where the community has waited long enough; strengthen the roll-out of advanced nurse practitioners to ensure consistent care where GPs hours are limited; improve communication and transparency; and work with local communities and practitioners to develop clear local solutions.

Mary Butler (Waterford, Fianna Fail)
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Gabhaim buíochas leis an Teachta. I thank the Deputy for his question about primary care provision for Rathdowney and Mountrath. I am taking this question on behalf of the Minister for Health, Deputy Carroll MacNeill. He raised a couple of matters: plans for succession in GP practices, challenges in rural Laois and the primary care centres in Mountrath and Rathdowney. I will do my best to address all of those issues.

As the Deputy will be aware, timely access to GP and primary care services is vital for the successful delivery of our healthcare service. They are our first port of call.

In regard to general practice, as he will also be aware, GPs are private practitioners, most of whom hold contracts with the HSE for the provision of public health services. Currently, almost 3,200 GPs hold at least one HSE contract, including roughly 2,600 GPs who hold a general medical services, GMS, contract for the provision of care.

As private practitioners, GPs themselves determine the location they practice from, which can be difficult. However, in addition to undertaking to increase the overall number of GPs practising in the State, the Government is committed to ensuring that services are available throughout the country on an equitable basis, and in particular to supporting GP practices in rural and underserved areas.

Significantly increased investment in general practice has been provided for under the 2019 and 2023 GP agreements. The agreements provide, among other things, for increased GP fees and practice supports, including a 10% increase to rural practice supports and increases to supports for staff capacity. We are conscious of the challenges in rural areas.

The number of new entrant GP training places has been increased by 80% from 2019 to 2024, with 350 new entrant places available since last year. I accept they take time to come through the system, but there is a huge improvement. Furthermore, recruitment of GPs from abroad continues under the international medical graduates, IMG, programme, whose placement is targeted to underserved areas.

Just recently, a new locum support initiative commenced, providing GPs in receipt of rural practice supports with access to a streamlined locum recruitment service. The initiative is initially focusing on supporting the more than 130 single-handed GPs working in isolated areas. That has just commenced.

At present there are no GMS GP vacancies in County Laois. Where a vacancy arises, the HSE actively recruits for a replacement GP while providing for the continuity of services.

Regarding the provision of primary care services, we are making steady progress on the development of primary care infrastructure in County Laois, which is currently served by primary care centres, PCCs, in Mountmellick and Portarlington with two further PCCs under development in Portlaoise and Rathdowney. I know the Deputy is particularly concerned with service provision in Mountrath and Rathdowney and I am happy to advise the following in their regard. It is intended that the PCC in Rathdowney will be delivered via the operational lease mechanism. In 2024, the HSE sought expressions of interest for this development and several valid tender submissions were received. The HSE is currently working through the tender assessments and internal approvals processes. Once this process is complete and all approvals are received, the successful tenderer will be notified which will allow for progression through the design and planning stages in 2025.

The HSE Capital Plan 2025 includes funding to progress designs for the provision of primary care services in Mountrath. The HSE has advised that the current plans for Mountrath include the redevelopment of the existing Mountrath Health Centre site, including an extension and refurbishment of the existing building. This follows a reassessment of service needs, which indicated that the existing HSE-owned site could accommodate the service needs of the area. I expect the extension will be delivered much quicker than a primary care centre.

William Aird (Laois, Fine Gael)
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I thank the Minister of State for her response. However, it is important that I stress again that I am not asking for extras for County Laois. I am asking for the basics, that is, access to a doctor, reasonable wait times, and care delivered in our towns and villages. Rural Laois deserves the same healthcare rights as any other part of this country. People have paid into the system for their entire lives and they deserve more than just a waiting list and closed doors. To be fair to the Minister of State, I know she agrees with me.

Time is not on our side. GPs are retiring now, not in five years. Locum cover is inconsistent. Rural patients are falling through the cracks in County Laois. The Minister of State referred to the situation in Rathdowney. I heard her say 2025, but I got the same answer in 2024. I am sorry to have to say that. It is in no way a criticism of the Minister of State for the response she has given me, because the Minister is not present, but I have heard all this before.

No site has yet been confirmed in Rathdowney. That is evident in the Minister of State's response to me. The HSE's silence on progress is adding to the frustration of the community in Rathdowney. Mountrath has been allocated a primary care centre but, without a clear timeline for delivery or a staffing plan what is proposed is just a promise. I tried to find out if it was true or false that a site has been allocated but I could not get a definite answer, which means we are also left in limbo.

I am not asking for County Laois to jump the queue but I cannot accept that rural communities in the county are being left behind. We need a clear roadmap with deadlines and funding commitments. We need boots on the ground: doctors, nurses and therapists who can deliver care now. This is about dignity. It is not about access or equity. I do not want the people of Laois to wait any longer for those services.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy very much for raising the issue of rural GP practices in County Laois. He said a site has not been identified for a primary care centre in Rathdowney. That is normal. It is because it is commercially sensitive. If the HSE has not purchased a site, it could drive up prices. I have seen the exact same situation in Lismore in County Waterford, where a site was not identified in advance of the agreement being made on the operation of the lease mechanism. People on the ground probably know where the site is located.

William Aird (Laois, Fine Gael)
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We do not.

Mary Butler (Waterford, Fianna Fail)
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But that is the reason that is the case. If the HSE does not own the site and it talks about where it is, straightaway, in the main, prices can go up, so there is a commercial sensitivity around it.

William Aird (Laois, Fine Gael)
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That is what was said 12 months ago.

Mary Butler (Waterford, Fianna Fail)
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The HSE also tells me that there are no general medical services GP vacancies in County Louth. As we know, when a vacancy arises, the HSE actively recruits.

I have a couple of positives for the Deputy. The new locum support initiative has commenced, which provides GPs in receipt of rural practice supports with access to a streamlined local recruitment service. This initiative is initially focusing on supporting the more than 130 single-handed GPs working in isolated areas.

I will bring his concerns back to the Minister and he will probably discuss with her the primary care centre in Rathdowney. It is positive that we are going to see an extension of the service in the existing primary care centre. The site is big enough for that to happen and the extension of services can happen much quicker. I know that from my own experience.

The development of primary care infrastructure in County Laois is progressing. The Deputy Aird is correct that we want to bring the right care at the right time as close to home as possible. I will pass on his concerns to the Minister.