Seán Fleming (Laois, Fianna Fail)
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7. To ask the Minister for Health her plans for a new GP contract; and if she will make a statement on the matter. [17324/26]

John Paul O'Shea (Cork North-West, Fine Gael)
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21. To ask the Minister for Health the number of approved general practitioner posts currently vacant in Cork; the measures being taken to recruit and retain GPs, particularly in rural areas of Cork; and if she will make a statement on the matter. [16272/26]

Martin Daly (Roscommon-Galway, Fianna Fail)
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What are the Minister's plans for a new GP contract and what is the progress on the strategic review of general practice? I ask this in the context of our growing population, the increasing expectations and demands on our health service, the increasing expense of secondary and tertiary care, and the long-term need to treat patients with less complex problems in the most appropriate setting - namely, a primary care setting - by GPs and supported by full primary care teams.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I propose to take Questions Nos. 7 and 21 together.

I assure the Deputies that the Government is committed to the continued development of our general practice service and improving access to GP services for all patients around the country. Over €340 million in additional annual investment in general practice has been provided under the 2019 and 2023 GP GMS agreements. Those agreements provide for increased GP capitation fees, increased and new supports for practices and new fees for additional services. By any measure, that is a considerable support provided by the State and by the taxpayer to private practices. It is important to remember that. The positive impact of this investment is seen in the increased number of doctors both applying for and undertaking GP training. Annual intake into the GP training scheme increased by 80% from 2019 to 2024. We have further increased the number of new entrant training places this year by 50 to 400. In addition, recruitment of GPs from abroad continues under the international medical graduate rural GP programme, which targets the placement of GPs to rural and under-served areas.

A strategic review of general practice that is examining the range of issues affecting it is under way and will be completed this year. The review will examine issues related to capacity and will consider further possible mechanisms to attract GPs to rural and under-served areas. The review will set out recommended actions for more sustainable general practice delivery for the whole community. While the existing GMS GP contract has been significantly updated, including via a circular, a new approach must also be developed. The strategic review will identify the arrangements necessary to improve our current system of GP care and that will determine any changes required in a new contract.

There is hugely significant investment in GPs, particularly in chronic disease management, which has been of real benefit to the broader healthcare system. Regarding the chronic disease management programme, the State has invested in GP services for the benefit of people of a particular age who may face chronic diseases. This is showing dividends in terms of patient care and in terms of the number of exacerbations and presentations to acute hospitals. People are living better with chronic diseases because of our investment in GPs and because they can access it more easily.

I am concerned that there is not the same availability of out-of-hours GPs across the regions. That is putting additional pressures on emergency departments and local injury units, particularly at a time of rising population. I am particularly conscious of that in the mid-west and south west, but it is a national profile. That is something I need to make sure is included in any new contract. I have a number of other reflections about maximising the use of GP services so that we are getting the best in the community and reducing hospital presentations.

It is important to say that our development of pharmacy contracts enables better access to GPs. Let me say loudly again that you do not need to go to your GP for eight conditions, including a simple eye infection, thrush or a urinary tract infection. You can go directly to your pharmacy and pay €30 for a consultation with a pharmacist, a diagnosis and a prescription. You need never go to two different places when you have such conditions. Who does that matter for? Everybody. It matters because it creates more space in GP practices for somebody who needs a prescription for a urinary tract infection. For an older lady, such an infection is a really serious thing that can get much worse and result in hospitalisation. Because we have changed the pathway, people can get quicker diagnosis and an appropriate prescription to clear up a basic but important and potentially risky infection. In all those ways, we have tried to expand access to appropriate medical care.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the Minister for her answer. First, they are private practices but the State has chosen to operate a contract of service-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Correct.

Martin Daly (Roscommon-Galway, Fianna Fail)
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-----and that has suited the State well in recent years.

The Minister is right that if a GP has a GMS contract, he or she is obliged to be available and provide an out-of-hours service. Many younger GPs are choosing not to sign GMS contracts with the State because of that obligation. I agree 100% with the Minister that we really need to rethink the out-of-hours framework. It may well need to be separate from the GP contract because an increasingly older population of GPs are carrying that out-of-hours burden.

We need to rethink premises. We are relying on a private developer model. That has not worked in many rural or inner-city areas where we need State-led, HSE built premises - I would say rent free - to attract GPs to those areas.

Finally, we need public salary GPs in some remote rural areas and in deprived urban areas.

John Paul O'Shea (Cork North-West, Fine Gael)
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The issue of vacant GP posts across Cork is placing serious pressure on communities, particularly in rural areas. Access to a GP is a cornerstone of our primary care system, yet in many towns and villages people are finding it increasingly difficult to register with a doctor or to secure a timely appointment. When GP posts remain vacant for long periods, the impact is felt immediately by the patient, by the neighbouring practices, which are already under pressure, and by the local health services. We need clear timelines and transparency from the HSE on how the vacancies can be filled and what interim measures are being put in place to ensure patients are not left without access to essential care.

Primary care must be strengthened. Two of the biggest issues that come up in my office every single week are access to a GP and access to consultant orthodontists in Cork. I urge the Minister to try to address those two issues for Cork over the next couple of weeks.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I find myself in agreement with all of the five points Deputy Daly made, such that I do not believe it is necessary to repeat them. I look forward to working with him on the practical points he has made, particularly in relation to the out of hours framework, the premises structure, what we might do and how we might think about that, and the development of that in terms of a tax-efficient way of encouraging activity. The Deputy correctly recognised the public-private element to it. I must also recognise it from the perspective of the taxpayer, and I think that is reasonably fair, but I do not see the need to repeat all those things that I already agree with him on, but I look forward to his input in how we improve them. I thank him for that.

In relation to Cork, while no GMS general practitioner posts are vacant in County Cork, I do understand, for example, in the area Deputy O'Shea represents, in Charleville, in particular, that there is a practice that is going from three GPs to two GPs. The impact that this has on the community is hugely significant. It should not be understated. While it is one GP, that is what matters. It is the hours that are available. It is the support that is there to the community. I recognise the point the Deputy is making. I know HSE officials are continuing to engage with him on that on behalf of his community.

In relation to the query regarding the orthodontic service in Cork, it is anticipated that the whole-time equivalent of specialist orthodontist will reduce to 2.83 from May 2026. That is on foot of three clinical staff retiring from duty, and that has a big impact. Plans to restore the whole-time equivalent levels of specialist orthodontist and senior surgeon posts are being advanced and finalised in HSE south west. In terms of any anticipated retirements for this year, we have not received any indications of retirements from the remaining clinicians but a specialist orthodontist has been on periods of sick leave, which is impacting further delivery. We had a conversation about the importance of that earlier. I thank the Deputy for raising it.

Martin Daly (Roscommon-Galway, Fianna Fail)
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I acknowledge the investment of the State in general practitioner services over the past number of years. I think the Minister would recognise that with our growing population - 90,000 a year - the increased expectation and sophistication in what they want from a functioning health service has increased. We are not accelerating the capacity at the rate we are going to have to. We are talking about having 6,000 GPs in 15 years' time in order to meet that demand. We have 4,200 GPs who are registered as GPs but they are not whole-time equivalents. Many of them are in part-time practice. That is just the changing way people and younger doctors work. We need to find a way of getting the full contribution from GP training, in that the State has invested huge amounts of money to get them into general practitioner services in the country, so that it can be sustainable into the future.

John Paul O'Shea (Cork North-West, Fine Gael)
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I thank the Minister for her continued engagement and interest in the health services in Cork, particularly in terms of GP services. They are a first point of contact for many people. While it is great to see that there are no current vacancies in the GP contracts in Cork, our population in Cork is growing substantially, particularly in rural County Cork, where every single town and village is growing by the number of new houses there. There is particularly a need in Charleville. I thank the Minister for mentioning my town of Charleville that I represent. There is an acute need in terms of getting a new GP contract there because the population of Charleville is increasing significantly. We need additional supports there into the future.

I am receiving increasingly more queries into my office in relation to consultant orthodontists. There seems to be an issue where we do not have enough staff. There seems to be no plan in terms of recruiting a consultant orthodontist. I urge the Minister to see if she can engage with the HSE and with me to encourage more recruitment as we go forward in the next couple of months.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Let me be very clear in relation to the recruitment. Any delay should only be in actually finding the consultant orthodontist and bringing them into the system. That does take time because people have to leave posts and so on but there should not be any delay at a HSE level recognising the level of need I have described to the Deputy and have described more broadly.

In relation to GPs generally, we have expanded the training programmes and the numbers again and again. We do want them to work. We cannot force them to work as GPs in Ireland and we cannot force them to work in the public health system but that is what we want. Again, I think it is time to reflect on the level of investment that we put into training medical practitioners on behalf of the State. It is such a privilege to be able to do that and not charge the fees that would be charged in any other country to train as a medical practitioner and the opportunity that it gives people. We spoke about with dentists and spending a period in the public system. We want to develop a cohort of public GPs. There is no question about that, and we have to think about the ways in which we give people the opportunity, or make it a requirement, to spend time in the public service to get the benefit of that particular model.

In relation to out of hours, it is really important to reflect on that, particularly in rural Ireland and where it can be more difficult to get to somebody that you need. I was reflecting on Cork in particular in anticipation of the Deputy's question. In relation to Kanturk and Mallow, for example, there were issues going back in 2023 and 2024 that the Deputy will be aware of better than I in relation to Kanturk and Macroom treatment services. The HSE did engage with SouthDoc on the matter, which confirmed that the centres were to be available by appointment only. It has been improved somewhat. I am now aware that there is an on duty doctor physically present in the Mallow treatment centre each weekday night, which is important. They can see routine patients provide telephone clinical advice and travel to locations such as Kanturk to provide home visits. That is the support that is necessary in addition to a second doctor in situ at weekends in public hospitals. We do need that out of hours facility, as Deputy Daly has highlighted. We need to continue to make sure that this is part of the GP offering.