Tim Lombard (Fine Gael)
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I welcome the Minister of State to the Chamber. I raise the issue of medical cover required on Saturday mornings in the towns of Clonakilty, Skibbereen, Rosscarbery, Enniskeane and Kinsale. Unfortunately, there is a dispute between the GPs and the HSE about who covers what and when. As a result, there is the potential there will be no such GP cover across the entire west Cork. There has been a breakdown in communication and trust. Particularly now when we all need to pull together to deal with the Covid crisis, it does not make any logical sense for the HSE, without consultation, to have pulled payments for Saturday morning cover since last July for a cohort of GPs across west Cork. Since last July, the GPs who cover those Saturday morning clinics have not received payment for those clinics. Effectively, they are working for free. They are providing a service to the community for which they are not receiving payment. That is a change in practice by the primary care reimbursement service without any consultation with the GPs. There has always been a lag in payments and those GPs were expecting to receive payment six to eight weeks later but since July payments were stopped without consultation. There is a fear that an apartheid system could develop with those GPs only covering private patients and not public patients whom they are also obliged to cover. This is a major issue. As the Minister of State is aware, there is a crisis with respect to the shortage of GPs going into GP practice. There is a lack of confidence among GPs about the sustainability of GP practices. As a result of this dispute more and more GPs will walk away from this service. With the Covid crisis, there could be a limit on cover for these Saturday morning clinics in west Cork, which would result in increased activity, particularly in accident and emergency departments, which we would not want to see happen. We want patients to be provided with the medical cover they need in those towns. We do not want them to have to go the Cork University Hospital for it.

I raise this issue because it is of major concern to the people of west Cork. What will happen to Saturday morning medical cover across these towns is part of a major debate. Consultation has failed and there has been a complete breakdown in communication. The HSE needs to actively engage with that cohort of GPs to make sure there is a service on Saturday mornings across those west Cork towns. If not, the outcome will be disastrous. That is the dilemma we face due to a lack of communication, consultation and pre-planning for what should be a key service. Primary health care is a key service and we need to make sure it is maintained. Unfortunately, it is not being maintained at the moment.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Senator for raising this important issue and one which, I know from my discussions with him, is of major concern to him and his constituents in Cork.

Under the general medical services, GMS, contract, GPs must be available to provide services in their practice premises or by way of domiciliary visits, as appropriate, for their medical card and GP visit card patients for 40 hours each week. They must also make arrangements to enable contact to be made with them, or a locum-deputy, for urgent cases outside these 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 have been developed and expanded over time and are now an essential and positive part of primary care services. This helps to ensure that, to the greatest extent possible, urgent care needs are met in the primary care setting.

SouthDoc provides a Saturday morning service in most areas in the Cork-Kerry region. This service has been advanced incrementally in recent years in response to requests from various local out-of-hours cells. The majority of areas are now included in the Saturday morning service. However, there are a number of areas where the Saturday morning service is being provided by individual practices, as opposed to being operated by SouthDoc.

Following engagement with the Irish Medical Organisation, a grant-based system of funding for GP out-of-hours co-operatives has been in place since March 2020 to support out-of-hours services during the pandemic. In accordance with the agreed system, no out-of-hours or other claims for consultations during a co-operative's hours of operation are claimable by the co-operative or its members from the HSE primary care reimbursement service, PCRS. The PCRS has a legal obligation to ensure resources are used for the purpose for which they are intended and is obliged to verify the reasonableness and accuracy of all claims submitted for payment. A validation mechanism exists for claims made by co-operative members during the hours of operation of grant-aided co-operatives.

The PCRS has provided a specific email address and a contact point for GPs who may have any queries or concerns regarding the validation mechanism or their GMS remuneration. If GPs who are not co-operative members, or who do not have co-operative cover available to them, are inadvertently captured by the PCRS validation process, they should notify the PCRS straightaway. Where a GP can provide information that clarifies that any claim held under the validation mechanism is in line with the GP's contract, then the PCRS will ensure that the claim is paid.

I have been informed that Cork Kerry Community Healthcare has recently learned of the decision by the PCRS to cease payments to GPs who are running their Saturday morning service outside the SouthDoc co-operative. Cork Kerry Community Healthcare is currently determining the specifics and will be engaging with the GPs who have notified it of this issue, as well as the other stakeholders as a matter or priority. Cork Kerry Community Healthcare is working locally with all stakeholders to ensure appropriate and safe service levels are maintained. This involves a level of detail regarding contracts and State processes. As the Senator knows, with regard to the systems, the PCRS and others need to make sure that funds are dedicated to where they should go. I completely take on board the concern this issue is causing locally with healthcare providers on the ground and their patients, the Senator's constituents, who are concerned about medical cover into the future. I will be working with ministerial colleagues to ensure the concerns the Senator raised are highlighted and that there is detailed ongoing negotiation and contact with all the relevant parties to make sure this issue and the potential impasse are resolved.

Tim Lombard (Fine Gael)
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I thank the Minister of State for his comprehensive response. The stopping of the payments for these GPs since July has left some GP practices with potential financial issues. That is unfortunate. Confidence among GPs in practices is a major issue. Engagement is needed to address this issue. I raised this issue at the health board forum last Friday. We need to make sure the HSE deals directly with those GPs to find a solution. What is happening currently cannot continue. We could have up to 5,000 or 6,000 Covid cases in a few weeks' time and it makes no sense for GPs not to be paid for their work. It makes a laugh of the suggestion that we are all in this together. The Minister of State's involvement is welcome. It is important those GPs and the HSE have meaningful engagement to sort out this major issue for those communities.

Martin Heydon (Kildare South, Fine Gael)
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It is important to state the Government acknowledges the vital role GPs have played, particularly during the fight against the Covid-19 pandemic and, more generally, in providing essential healthcare in the community. We, as a Government, are committed to ensuring that patients across the country continue to have access to GP services, including out-of-hours services such as those the Senator has raised.

A package of measures to support general practice was introduced in March 2020 in order to take account of the impact of Covid on general practice and to ensure that GPs were in a position to provide essential Covid and non-Covid services, which they have done. In addition, in recognition of the need for the continuance of GP out-of-hours services, the HSE is providing grants to support the out-of-hours co-operatives.

The HSE's PCRS is responsible for making payments to primary care contractors, including GPs. Payments totalling in excess of €780 million were made to GPs by the PCRS in 2020. As I stated, the PCRS is responsible for verifying the reasonableness and accuracy of all claims submitted for payment.

I would encourage any GPs in the Senator's area who have concerns or issues to engage directly with the PCRS. It has provided a dedicated email address for GPs, which I will furnish to the Senator.Claims that can be validated by the primary care reimbursement service as being in line with the GP contract will be paid. In the meantime, Cork Kerry Community Healthcare has recently been made aware of the non-payment of claims to GPs who are providing a Saturday morning service outside the SouthDoc group. It is looking into this issue and will be engaging with GPs, the PCRS and other stakeholders as a matter of priority to resolve it. I will ensure engagement happens as swiftly as possible to try to get a resolution to what is a very concerning issue for the people of the Senator's area.

Tim Lombard (Fine Gael)
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I thank the Minister of State.