Mary Butler (Waterford, Fianna Fail) | Oireachtas source

This is my first time to speak in this fantastic Seanad Chamber. I took Commencement matters in the Dáil yesterday, but I think at times we forget that this is such a fantastic building. I am pleased to be here.

I want to thank Senator Kyne for raising this important issue and I am taking this matter on behalf of the Minister, Deputy Stephen Donnelly. There are huge challenges to meet in respect of the provision of GP and out-of-hours services, particularly in rural areas. Please be assured that the Government is committed to enhancing primary health care services throughout the country, including out-of-hours GP services. 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 are required by their contract to make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside of 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 facilitate the provision of GP services outside of normal surgery hours and help to spread the burden of this provision.

I take on board the point made by Senator Kyne that some doctors have applied to join the out-of-hours co-operative, and I will take that back to the Minister. I find it hard to understand why, when there is a shortage of doctors, they are finding it difficult to access a co-operative. It is strange.

The HSE provides substantial funding to support the out-of-hours co-operatives, including the costs of triage nurses, call centres, treatment centres, drivers, cars and receptionists. This amounts to more than €90 million per annum and helps to ensure that, to the greatest extent possible, urgent care needs are met in the primary care setting.

The Westdoc co-operative is owned and managed by a group of participating GPs who provide out-of-hours GP services in the community healthcare west region, covering counties Galway, Mayo and Roscommon.

Funding for the service is provided through a service level arrangement with HSE community healthcare organisation, CHO, 2. In 2020, this organisation received almost €3.9 million in funding through this arrangement. In 2019, in addition to the funding allocated through the service level arrangement, HSE primary care operations allocated an additional sum of €150,000 to CHO 2 for the provision of extra staffing for the GP rota in rural areas. I understand that CHO 2 engaged directly with Westdoc to ensure that this funding was allocated to the area of greatest priority within that service, extending weekend cover in north Connemara, south Connemara and Achill.It is acknowledged that the Westdoc service does not extend to certain rural areas within the region, and that additional funding would be required to extend the service that is currently being provided. I understand that this places additional pressures on GPs in the area.

I assure the House that the Government is committed to ensuring that existing GP services in these areas are retained and that general practice remains an attractive career option. I want to ensure that patients throughout the country continue to have access to GP services, including out-of-hours services, and that general practice is sustainable in all areas into the future. We will continue to monitor and review services across the country to that end.

Measures to improve recruitment and retention in general practice have been implemented in recent years. The agreement reached in 2019 on GP contractual reforms and service developments will result in an increase in expenditure on GP services of €210 million annually by 2023. As the agreement sets out, increased capitation fees have been introduced, and there will be additional increases in the coming years. Enhanced supports for rural GP practices have been introduced under the 2019 agreement, including a 10% increase in the allowance for rural practices and a 28% increase in dispensing fees paid to GPs.