Robbie Gallagher (Fianna Fail)
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General practitioner services have been declining in recent years and, as a result, there is a chronic shortage of GPs throughout the country. It is impossible to get GPs to locate in rural Ireland and the people in towns and villages throughout the country are left with very few services or none at all. A recent report, commissioned by the HSE, highlighted the fact that the GP shortage would probably get worse before it got better.

A combination of factors are involved. First, a large number of GPs are due to retire in the next ten years and their posts may not be filled, with many young doctors planning to emigrate rather than stay in this country. Last week, I took two calls from families in County Monaghan, one in Carrickmacross and one in Monaghan town. Both had moved to the area recently and they went to every GP in both towns but no one would take them on. Where are such people meant to go in such a situation? The local GP is, for many people, the first port of call when they are sick and in need of medical care. If there are not enough GPs, where are these families supposed to go? They have no choice but to go to an overcrowded emergency department in Cavan or Drogheda, making the problems in these departments worse. It is a vicious circle and patients are going to suffer. Doctors are not to blame. They are under increasing pressure with more patients and longer hours. Some work on call at weekends and they cannot do any more. They are not getting a fair deal from the HSE and I want to see a GP service with primary care centres that are properly resourced. GP numbers must be increased and doctors incentivised to come to rural towns and villages. Until that happens our health services will deteriorate further.

Ireland is facing an estimated shortage of 1,380 GPs by 2025 unless urgent steps are taken to address this issue. A recent HSE report recommends 138 training places per year just to keep up with current demand. The report also recommends the introduction of a number of recruitment and retention strategies, including incentives to GPs to work up to the age of 70 if they wish, measures aimed at rural Ireland to encourage GPs to locate there and more trainees and graduates. Further research into areas such as the expansion of nurse-led care should also be carried out and there needs to be a proper ring-fencing of primary care, especially in respect of GP practices. A properly functioning GP practice leads to the best health outcomes and the best value for money.

Urgent action is required on this issue before the crisis gets worse and I look forward to hearing what plans the Minister brings to this House today to address it.

Helen McEntee (Meath East, Fine Gael)
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I thank the Senator and apologise on behalf of the Minister, who cannot be here. I assure the Senator that the Government is committed to enhancing primary health care services, including 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.The Government is committed to ensuring that patients throughout the country continue to have access to GP services, especially in remote rural areas and 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 for newly-qualified GPs.

A Programme for a Partnership Government contains a commitment in respect of 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. Of course, the Minister is anxious to achieve further increases in future years in order to ensure that the future manpower needs of general practice can be met. The Senator rightly outlined the figures that we need to reach for that to happen. There are currently 34 GMS GPs in Cavan covering 37 panels and 25 GMS GPs in Monaghan covering 28 panels. Obviously, there are three vacancies in each county. It should be noted, however, that all these panels with vacancies are covered by locum arrangements and that no panel is without a GP. The HSE is working to fill these locum panels on a permanent basis as quickly as possible.

It is acknowledged that there have been some difficulties in finding GP cover, both locum and permanent, for some rural areas. This includes Cavan-Monaghan. The HSE is working on a continuous basis with GPs to find solutions to this problem. In this regard, the Dublin north east training area increased the number of GP trainees by four last year, bringing the total number of trainees to 18. The number will increase to 19 this year, making the area one of the largest training centres in the country. This increase in trainee numbers should hopefully benefit the north east in the coming years.

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 and shared GMS GP contracts and changes to the retirement provisions for GPs under the GMS scheme. This allows GPs to hold GMS contracts until their 72nd birthday, if that is what they want to do. An enhanced supports package for rural GP practices has also been introduced. Some 252 practice units are in receipt of supports under the rural practice support framework, which equates to 313 individual GPs currently benefiting under the new scheme. This is a significant increase in the number of GPs benefiting from rural supports, which stood at 167 before the introduction of this scheme.

These steps should help to address the future demand by enticing GPs who may have ceased practising for family or other reasons back into the workforce, facilitating GPs to work past the standard retirement age and encouraging more GPs to work in more rural areas. In addition, the Minister and I are cognisant of the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector. Health service management have already progressed a number of significant measures through engagement with GP representatives.

Discussions on a new GP contract are under way. The aim is to develop a new modern GP services contract, which we have not had in a number of years, that will incorporate a range of standard and enhanced services to be delivered. The GP contract review process will also seek to introduce further measures aimed at making general practice a fulfilling and rewarding career option into the future. I obviously hope that our young doctors will not leave the country to pursue careers elsewhere.

Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for her extensive response to my question. To get back to the two people who contacted me last week about the lack of GPs, I wonder if there is anything in the Minister of State's response that will give them comfort. I sincerely hope there is. I welcome the fact that more places are going to be made available for training. The problem is, like in many other sectors such as nursing, teaching or whatever, we seem to be training our nurses and doctors to emigrate and find better packages and deals elsewhere. That is a big factor. It is something we are going to have to challenge. We need some creative thinking in order to do that. I thank the Minister of State for her response.

Helen McEntee (Meath East, Fine Gael)
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I do acknowledge the difficulties that we are facing. There are currently 23 overall vacancies, six of which are in Cavan-Monaghan alone. Obviously, the HSE must put a lot of its effort into ensuring that those places are filled. I also recognise - and I believe the Department recognises - that the ratio of GPs to the population in the Senator's own area may be slightly lower. That is because of the difficulty in attracting GPs to rural areas. GPs are private practices. It is up to the individual to come to an area. Where it has not been successful, the HSE is obviously looking to bring people into those areas, but it is difficult. The changes to the retirement age, the opening up of access to the GMS panel, the changing of work hours for young mothers who may also want to raise families and the new rural contract linked in with the GP contract itself will hopefully start to see changes and encourage GPs to work in these areas in which they are not currently working.