Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I assure the House that the Government is strongly committed to the future of rural Ireland. We recognise the contribution that rural communities have made to overall national economic development and the development of local areas. Our vision is of rural areas that are vibrant, inclusive and thriving economically . People in rural communities should experience a quality of life that is at least as high, and probably better in several respects, as that experienced in urban areas. The Government is committed to ensuring patients throughout the country continue to have access to GP services, especially in remote rural areas. We will ensure general practice is sustainable in such areas into the future.

The HSE, the Department of Health and Irish Medical Organisation are engaged in a comprehensive review of the general medical services and of other publicly-funded health sector GP contracts. One of the issues encompassed by this review process is support for general practice, especially in remote rural areas. While I do not propose to comment on the detail of the ongoing negotiations, I wish to depart from the prepared script by saying we are looking at the possibility of practice nurses being hired by the State so that GPs are no longer responsible for their recruitment. I think this is one of the issues that will be discussed in the negotiations, even if it is not completed or agreed on. Under the current general medical services contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual allowance of just over €16,200. They also qualify for more favourable subsidies towards the employment of staff, including practice nurses and secretarial support. More advantageous supports for locum costs for leave are also payable.

The HSE has recently produced revised rural practice allowance guidelines for remote rural areas. The purpose of the new guidelines is to ensure consistency, transparency and fairness when decisions are made about the relevant discretionary provisions of the general medical services contract as they apply to rural GP practices. The guidelines also provide for a level of flexibility in considering applications from GPs which is greater than that provided for in the original governing circular. The guidelines also provide additional options to support GPs. From time to time, HSE local offices offer other incentives to attract GPs into rural areas, such as access to HSE facilities. Additional contracts are also offered, such as contracts to provide medical officer services to nursing homes.

I am aware that some isolated rural areas and deprived urban areas, often with limited private practice opportunities, may find it difficult to attract GPs to fill vacant posts. However, I have been assured by the HSE that where a general medical services GP vacancy arises, it takes the necessary steps to ensure continuity of service to general medical services patients is maintained. On 1 November last, there were just 20 general medical services lists out of a national total of more than 2,400 such lists without a permanent GP in place. Eight of the 20 vacancies are in rural areas with populations of less than 1,500. The full range of GP services continues to be provided to the patients concerned through a locum GP or a neighbouring GP. A key objective of the engagement that is taking place with the Irish Medical Organisation at present is to achieve revised and modernised contractual arrangements which support the sustainable delivery of enhanced GP services in local communities. These services constitute a key element of the range of public and privately provided services, including health and social services, that people need so that life in rural areas remains attractive and sustainable for them at all stages of their lives.