Catherine Byrne (Dublin South Central, Fine Gael) | Oireachtas source

On behalf of the Minister, Deputy Harris, I thank the Senator for raising this issue.

At the outset, I would like to assure the House that the Government is committed to enhancing primary health care services, including GP services, throughout the country. The development of primary care is central to the Government's objective to deliver a high quality, integrated and cost-effective health service.

GPs contracted under the General Medical Services scheme must make suitable arrangements to enable contact to be made with them, a locum or a deputy for emergencies outside normal practice hours. While there is no obligation on GPs to participate in GP out-of-hours co-operatives as a means of meeting the contractual requirement, such services have been developed and expanded over time and are now an essential part of the primary care services. This helps to ensure that, to the greatest extent possible, urgent care needs are met in the primary care setting.

As the Senator will be aware, in the mid-west region out-of-hours arrangements are discharged through Shannondoc, a not-for-profit GP co-operative owned and managed by a group of individual GPs across Limerick, Clare and north Tipperary, which is funded by the HSE. The HSE has signed a service arrangement with Shannondoc for 2017. Last year, Shannondoc announced that, due to a difficulty in attracting GPs, in particular, locum cover, it was no longer able to maintain its existing service across all its centres. Following discussions with Shannondoc, in order to ensure the sustainability of the service, the HSE accepted a proposal from the co-operative to changes in the provision of the service. The HSE's funding model to Shannondoc has not been altered and the changes to service provision decided on were not influenced by the availability of funding from the HSE. The most significant changes relate to part of east and west Clare, essentially affecting Ennistymon, Kilrush, and Killaloe, with minor changes in terms of operating hours in two locations in north Tipperary.

The changes made to the Shannondoc out-of-hours services are subject to a three-monthly review and their impact is being closely monitored and evaluated by the HSE. There have been no further changes in the provision of Shannondoc services to date. The Government is committed to ensuring that patients throughout the country continue to have access to GP services, especially in remote rural areas and also in disadvantaged urban areas, and that general practice is sustainable in all areas into the future. It is imperative that existing GP services in these areas are retained and that general practice remains an attractive career option.

As part of ongoing attempts to provide additional supports to GP services, and to ensure the future provision of these services in all areas, the programme for partnership Government commits to increasing the number of GP training places to 259 places annually. In July 2016, the GP training intake increased from 157 to 172 places and the HSE's 2017 National Service Plan envisages a further increase, to 187 places this year.

The Minister, Deputy Harris, is anxious to achieve further increases in future years in order to ensure that the future manpower needs of general practice can be met. Further efforts undertaken in recent years to increase the number of practising GPs include changes to the entry provisions to the GMS scheme to accommodate more flexible-shared GMS-GP contracts, and to the retirement provisions for GPs under the GMS scheme. An enhanced supports package for rural GPs was also introduced last year.

The Minister has also emphasised the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector, and health service management have already progressed a number of significant measures through engagement with GP representatives. The GP contracts review process will, among other things, seek to introduce further measures aimed at making general practice a fulfilling and rewarding career option in the future.