John Whelan (Labour)
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I welcome the Minister of State to the House. While the question was directed to the Minister for Health, it is not at all inappropriate that it is being taken on his behalf today by the Minister of State, because of her remit with regard to rural development and rural areas. While it is not directly under the aegis of her Department, one of the newest challenges facing rural Ireland is for rural communities, towns and villages, to retain their GP services. This is a relatively new phenomenon.According to my information, the HSE is experiencing chronic difficulty in filling vacancies where GPs have retired in 30 to 40 towns and villages in various regions throughout the country. In itself, this reflects a change of emphasis which we have seen manifested in other areas. A GP practice is no longer necessarily a vocational pursuit. Rather, it is often viewed as a career. These days, it must stack up as a business and a sustainable proposition, it must be feasible, and it must meet the demands and lifestyle expectations of people and families.

In particular, I wish to raise with the Minister of State the anxiety and alarm developing in my county, County Laois, due to the ongoing process and the length of time it is taking to find a GP replacement for the village of Borris-in-Ossory. The incumbent, Dr. Seamus Fitzgerald, a long-serving practitioner who has given sterling, loyal, committed and dedicated service, is retiring of his own volition. I wish him a happy, healthy and lengthy retirement. The process to replace him commenced as far back as last November. I am heartened to learn that there have been a number of expressions of interest. Indeed, perhaps up to four qualified candidates were interviewed for the competition to replace the incumbent, Dr. Fitzgerald. However, the vacancy looms large and will arise within a week's time at the end of March.

I hope the Minister of State will have a positive reply today to the effect that the Borris-in-Ossory vacancy has been resolved and successfully addressed by the HSE. In that context there is a wider issue that needs to be considered by the Minister for Health when he is negotiating the GP contract with GPs and the Irish Medical Organisation. A new trend is developing whereby new and younger doctors and practitioners are no longer willing to embrace general practices in smaller towns and villages throughout rural Ireland. As I have said, up to 40 vacancies exist at the moment, and this will accelerate unless it is addressed. With respect, this needs to be addressed by ensuring that the rural practice allowance is restored and that it is sufficient to make the practice attractive, feasible and sustainable. Moreover, we need to address the terms and conditions being sought from GPs, including the rents sought for the clinics they use in these town and villages. Towns and villages such as Borris-in-Ossory are not as lucrative as larger urban areas in the city of Dublin and so on. It is my understanding that the HSE is looking for an extortionate rent of €25 per square metre from the new GP for the clinic in Borris-in-Ossory. This is punitive. It is not consistent with the current market value and it puts a great strain on any doctor trying to provide a dedicated and committed service in Borris-in-Ossory and its extensive hinterland.

John Whelan (Labour)
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I acknowledge and thank the Minister of State for a positive and constructive response. It is heartening and positive news for the people of Borris-in-Ossory and surrounding areas that the HSE has managed to secure a replacement and that a new GP will take up duty imminently. I welcome that. However, it would be easier to recruit GPs to rural areas and other communities which are not as attractive for those setting up new practices if the criteria were more favourable and supportive of young GPs. The rural practice allowance for GPs needs to be reviewed, revised and reintroduced to areas where it has been withdrawn, such as in Borris-in-Ossory. It is scandalous that the funding has been withdrawn in this instance and others where it would help to make practices more viable, attractive and sustainable.

The Minister of State has responsibility for rural affairs and development and has an important role to play. One of the cornerstones of the viability of any village or rural areas is a GP practice in order that families can feel secure and safe and have recourse to such a service. Without it, the sustainability of a rural community is undermined. Will the Minister of State lend her voice and support to this issue? The criteria being applied by the HSE to practices such as that in Borris-in-Ossory are punitive, such as the rent it is seeking for the use of the HSE facilities and clinic there. The rate is €25 per sq. m, which the price for prime real estate. The clinic is not located in Dublin, and not everywhere is thriving in the same manner as the capital or is as prosperous. There is a strong case to be made for the HSE in this instance and others to waive the rental costs, at least in the first few years, in order that a practice can become established, take root and become committed, dedicated and viable for people in communities such as Borris-in-Ossory. The HSE needs to make a better effort and promptly review the criteria it applies.I am glad to hear it is part of an overall review, but time is of the essence because the Minister of State and her Government colleagues, including the Minister for Health, are facing an ongoing challenge across the regions of rural Ireland to fill vacancies for new GPs as they arise.