Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Sure, but that is what they said to me. We certainly do not want a situation where anyone feels that they are in any way second-class citizens. I am very happy to keep it under review.

With regard to GP prescribing, it is not covered in this Bill but again, I am more than happy to look at that because the Senator made some very fair points. Senator Dolan asked if the medical card adjustment can be applied retrospectively and the answer is "Yes", in that if somebody had a medical card, rented out a room and lost that medical card, he or she can be reassessed immediately. The €14,000 would be gone and if the person qualified for the medical card otherwise, he or she would certainly get it back. There would be no issue there.

On pharmacy places, I tried to get a quick update as the Senator was speaking but that was not forthcoming in the time available. In my view, we have to double the number of healthcare college places in the country, including pharmacy places. We have made progress. I was looking for exact figures but I will ask my officials to revert to the Senator with that information on the exact position. We have been working very closely with the Department for Further and Higher Education, Research, Innovation and Science, the now Taoiseach, Deputy Harris and the current Minister, Deputy O'Donovan, to expand a lot of healthcare courses, including medicine, nursing, health and social care, pharmacy and dentistry.

I fully agree with the points made about the rural GP programme. This has been raised with me by the ICGP and others. They have suggested that we build in more rotations in practices in rural areas. Student GPs tend to be younger and those who may not have spent much of their lives in rural areas often love those areas. A lot more of them are deciding to stay because they feel they are in paradise, particularly if they are doing placements along the west coast of Ireland or in the south west. They are doing placements in beautiful parts of our country that they have not really spent any time in and they are falling in love with them. They are saying that they want to go back as a qualified GP.

Within the new GP contract, we have included measures specifically aimed at rural GPs, including improvements to the rural GP allowance. There is also a new proviso whereby a general practice in a given base can take over another practice and have GPs moving between the two, which gives the advantage of scale. Younger GPs like working in bigger teams. They are not too keen on being the sole GP in a more rural area. We are only beginning to activate the provision now but it means that they might be in a practice with five GPs, meaning they get all of the benefits of different specialisms and interests and learning from each other but they can still fully run a smaller practice in a more rural area. We will see how it goes but we have the provision in place and it is now being used. We are very aware of it.

Finally, the good news when it comes to GPs is that we have tripled the number of training places and this year we have had the biggest number of applicants for those places ever. There is a lot of interest among medicine graduates in going on to become GPs, more than we have seen for a very long time. The tripling of training places means that today, for every one GP who retires, two GPs are entering practice. It is not perfectly like for like. GPs themselves say that older GPs tended to work longer hours and did a lot of the GP-on-call work themselves. The younger GPs are far more sensible. They want far more regular hours and they want more flexibility. We are not getting a one-for-one in terms of hours worked or amount of patient care delivered but in terms of doctors we are still getting a two to one replacement rate which, over time, is beginning to take the pressure off. However, in some areas there is still is a lot of pressure in terms of getting to see a GP quickly.