Robbie Gallagher (Fianna Fail)
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Cuirim fáilte roimh an Aire Stáit go dtí an Teach. I thank the Minister of State for taking time from his busy schedule to attend this debate. I wish to discuss the current crisis in general practitioner, GP, care throughout the country and particularly in rural counties such as Monaghan and Cavan. In County Monaghan I spoke to a young couple recently who have just returned home after working in Dublin. They told me they travelled to Monaghan town, where they hope to live, and knocked on every GP's door only to be told that every GP's list was full. They could not get access to a GP. When they went to Carrickmacross they got a similar message. Where are these young people to go for healthcare? The only option available to them is to stand in the queue in the accident and emergency department of the local hospital, which is in Cavan. That is a very sad state of affairs.

Unfortunately, this issue has been with us for some time. GPs have been banging this drum for a long time but the Government has not taken any notice. It has now reached a stage where people simply cannot get access to healthcare. When we get sick the first door we knock on is that of the local GP, but there is a serious problem when that knock cannot be answered. In addition to the shortage of GPs, there is a serious problem with the age profile of GPs. It is estimated that 17% of them are due to retire in the next five years. We are training approximately 180 GPs every year so that illustrates the nature and extent of the problem. Half of the doctors we are training, like many of our nurses and teachers, are jumping on an aeroplane as soon as they qualify and heading off to a foreign land where the terms and conditions of employment are much more attractive. It is a serious problem. I have spoken to some GPs and they told me they are being run into the ground. They are totally stressed out because they simply cannot cope with the numbers coming through their doors. Even when the doors are closed they are still in a serious position and cannot cope.

In summary, we need a health system in which people see the right healthcare provider at the right time and in the right place. The cost of treating a patient in hospital for one night is €1,200. Treating the same patient in their own bed and home costs less than €100. This is a serious problem and must be addressed. It is particularly acute in places such as Monaghan, Cavan and rural areas. We are trying to attract our young people home and to invest in the local economy to create jobs, but there will be a big problem if those people cannot get access to GP care, the first point of access to healthcare when they get sick. I hope the Minister of State will have news of serious attempts by the Government to address this matter.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Gallagher for raising this important issue. I am aware he has a keen interest in healthcare and does a great deal of work in Monaghan and Cavan in respect of my portfolio, which is disabilities.I am very conscious of that and I commend him on it.

I would like to assure the House that the Government is committed to the continued development of GP capacity to ensure that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas into the future. I want to ensure that existing GP services are retained and that general practice remains an attractive career option for newly-qualified GPs. As of 31 December 2018, 2,491 GPs hold GMS contracts with the HSE and this is continuing to increase year on year. A further 430 GPs hold other contracts to provide services such as immunisation, heartwatch, methadone and cancer screening. HSE community healthcare organisation area 1 has confirmed that there are currently 25 GMS GPs in Monaghan covering 27 GMS panels and there are 34 GMS GPs in Cavan covering 37 GMS panels. Two locum panels for Ballyjamesduff and Drumalee were advertised in the national newspapers last weekend, with a closing date for receipt of completed applications of 15 March 2019. The HSE primary care unit is also processing two open entry GPs for Cavan and is engaging with all GPs holding locum panels to discuss the future of these panels. All GMS panels are assigned to a GP and currently there are no panels without a GP. The HSE is not aware of any GMS patients without a GP in Cavan-Monaghan. There are nationally agreed processes in place that ensure that any person who cannot access a GMS GP will be assigned to a GP.

The Government is aware of workforce issues facing general practice - and I take on board the points raised by Senator Gallagher - including the influence of demographic factors, and has implemented a number of measures to improve recruitment and retention in general practice. These 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, allowing GPs to hold GMS contracts until their 72nd birthday, as well as the introduction of enhanced supports for rural GP practices. These steps should help to address the future demand for GPs by enticing GPs who may have ceased practicing 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 rural areas.

There has been a huge expansion in the number of places on GP training programmes in recent years. In 2009, there were 120 GP training places available, and in 2018, 193 places were filled, an increase of around 60% over this nine year period. The objective is to continue to achieve annual increases in the number of training places available while ensuring that all the places are filled.

It is acknowledged that there are many challenges in general practice. I agree with Senator Gallagher's point on this issue. That is why the Government remains committed to engaging with GP representatives on the development of a package of measures and reforms to modernise the current GMS contract.

Talks between the Department of Health, the HSE and the Irish Medical Organisation, IMO, as the established GP representative body, are continuing. Agreement on the delivery of these service improvements and contractual reforms has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis.

Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for his comprehensive response to my query. I met a farmer recently who was discussing the lack of GPs and where the country was going. He said it was terrible to think that nowadays if he had a sick animal in one of the cattle sheds in the morning or one which got sick in the middle of the night he could ring a vet and one would be out within a couple of hours but if a mother or father had a sick child and was trying to get access to a GP in some cases the GPs' doors would be closed purely because of their workload. That illustrates in very simple terms the gravity of the situation. I note from the Minister of State's comments that talks are going on. GPs will say they have been going on too long. There is a crisis, particularly in the rural counties such as Monaghan and Cavan.It is past time that this issue was taken more seriously and that the Government addressed the situation. The Minister of State outlined that there will be efforts to put in place assistance in respect of the medical cards and that those people will be seen at some point. What about the people who are working and do not have a medical card? How are they meant to survive and where are they meant to go if their children are sick if there are no GPs available?

Finian McGrath (Dublin Bay North, Independent)
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I reiterate the Government's commitment to ensuring that patients throughout the country continue to have access to quality general practitioner services. The Department of Health, the HSE and the Irish College of General Practitioners are committed to working together to improve recruitment and retention in general practice over the coming years. I take the Senator's point and note his story about the local farmer being able to get a vet in a matter of hours. I also take his point on the progress of the talks. The goal of the current phase of the GP contract talks is to reform and modernise the existing General Medical Services, GMS, contract. This will be key to making general practice a more attractive career to young doctors.

In respect of GP services in counties Cavan and Monaghan, I assure the Senator that the HSE is taking all necessary steps to ensure that the current GMS vacancies are filled as soon as possible. In the meantime, local arrangements are in place to ensure services to this community are retained while the recruitment processes are under way. Of course, the Senator has a very valid point on the other issue of GPs in rural areas. I will bring these major concerns back to the Minister, Deputy Harris.