Thursday, 1 October 2020
Nithe i dtosach suíonna - Commencement Matters
General Practitioner Services
I thank the Cathaoirleach for selecting this important matter for this morning's Commencement debate. While I want to focus on the Westdoc service today, this issue is related to the broader matter of general practice in Ireland.
As we know, general practice in Ireland is under severe pressure and is facing major challenges. We do not have enough GPs and after many years of service and dedication, many of our GPs are approaching retirement age. We did not train enough GPs and we do not have the supports in place to ensure that GPs open or join practices in Ireland once trained.
We do not invest adequately in primary care services in Ireland and a much greater portion of our overall health budget should be invested in primary care. The funding should recognise the unique relationships between GPs and their patients. It should prioritise care in the community and strive for outcomes that avoid ever having to attend crowded emergency departments or acute hospitals. Sadly, despite some progress in the last 18 months, particularly in the increase in the number attending GP training courses, communities across the country continue to lose their GPs. Areas such as Corrandulla and Oughterard in Galway, among others, have been left without a service or with a diminished service, forcing local people to travel to attend a GP.As this only relates to weekday GP services, the situation in respect of out-of-hours services is even more troubling. Despite the efforts of GPs serving in Moycullen, Rosscahill and Oughterard other areas, local GPs are still not included in the Westdoc service, the out-of-hours GP service for the west. The local GPs serving the Moycullen, Rosscahill and Oughterard areas are working flat out to provide a service out of hours and at weekends for their local communities. The HSE is currently, and I must emphasise that this is during a pandemic, providing locum cover on a one-in-five basis but only in the short term with no commitment to maintaining this provision into the future.
In many areas, over 90% of doctors are covered by out-of-hours services. In the area that I am talking about, the eastern part of Connemara, that coverage is barely over 60%. It is unfair, unsafe and unsound. The local community and GPs deserve better. More funding must be provided to Westdoc for its expansion in order that all communities are covered and have certainty of a comprehensive GP service 24 hours a day, seven days a week.
I have been contacted by Moycullen and Oughterard GPs, who have been refused entry to Westdoc and have requested intervention. To put this into context, they say that when they are on call, they are on call for 48 hours every fourth weekend and every fourth night, as well as providing full weekday services. As one can imagine, that is a very onerous task for them to undertake, both physically and mentally in terms of their own well-being, but also in relation to that of patients. A more sustainable model needs to be put in place and the funding must be provided for access to the Westdoc service for this local area.
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.
I thank the Minister of State for attending the House and for her reply. Like all Members, I know she recognises the importance of rural GP services. The importance of sustaining rural communities and providing services to them may seem like a broken record, but the GP is at the heart of that. When people retire after a long number of years, they may have 30 or 40 years of service in a community, it can be difficult to find a replacement. The area I have raised is not remote; it is seven miles from Galway city. I live in Moycullen and it covers Rosscahill and Oughterard. It is an increasingly built-up area. Doctors are under pressure. If there is an additional retirement in the coming years without the provision of adequate services, will a young doctor come into that? Would he or she decide to operate a weekday practice and, at the same time, commit to the every four weekends and 48 hours during the week in addition to the normal daytime service? Finding new doctors to come into a situation like that is onerous. There is a demand and, more important, a need in a expanding area. I welcome the provision of additional funds in 2019, which I fought for, but it was not directed to the area that I raise today. I welcome the Minister of State's commitment to bring the issue to the Minister. I will push it at local level to try and secure additional funding for Westdoc and get admission to the doctors serving the Moycullen, Rosscahill and Oughterard areas.
I acknowledge the important role that GPs play in the delivery of our health service and their commitment to providing a responsive and high-quality out-of-hours service to patients. This has never been more visible than in recent months but at any time it is a key strength in the delivery of healthcare. The Senator is quite right that GPs are the beating heart of most communities, and it is a significant source of comfort to residents to know that there is a GP close at hand. I accept that retaining GPs in practices is a major challenge; it is something I have witnessed in my constituency where a GP left and a new GP only replaced that person three years later. I understand that the demands of the out-of-hours commitment has been particularly challenging for GPs in rural areas and CHO west where there are gaps in the Westdoc service. The Minister acknowledges that. I reiterate that the Government is committed to ensuring that patients throughout the country continue to have access to quality GP services and I will bring the Senator's concerns to the Minister.