Seán Kyne (Fine Gael)
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I welcome the Minister of State at the Department of Health, Deputy Feighan, to the Chamber and thank the Cathaoirleach for choosing my Commencement matter.

I raised this topic in October 2020 with the Minster of State's ministerial colleague, Deputy Butler, who was here on behalf of the Minister for Health, Deputy Stephen Donnelly. I mentioned the Westdoc service that covers the general area of Moycullen, Rosscahill, Oughterard and the outskirts of Galway city. On that occasion I mentioned that when GPs are on call, they are on call for 48 hours every fourth weekend and every fourth night, as well as providing full weekday services. My concern was the inability to get a new doctor in Oughterard and one of the reasons is the pressures of work. Despite a willingness of doctors to join the Westdoc service, the funding was not provided. At that stage the Minister of State said that she would raise this matter. She also said that she found it strange that where there is a shortage of doctors, they find it difficult to access a co-operative.

A sum of €3.9 million was provided through a service level agreement with the HSE and community healthcare organisation, CHO, 2 in 2020. A number of weeks ago, Mr. Paul Reid and Ms Anne O'Connor attended a meeting of the Oireachtas Joint Committee on Health. We talked about the winter plan and acute beds, of which there are none planned for Galway. I asked what would be put in its place and said one of the areas that we are looking at is enhanced funding for GPs. Ms O'Connor, as the director of operations for the HSE, said that there would be €10 million in additional supports for GP services to support those practices and areas that come under pressure, particularly single-handed GP services. She also said that the HSE would look at enhanced GP services and cover in the west as part of the winter plan. So it is quite clear that there is a gap in service provision. There is some funding available through the HSE. As there is pressure on the emergency system in Galway, clearly there is a need. There is funding and of course this is a preventative measure that will reduce pressure on emergency departments. The winter plan is an opportunity to put in place Westdoc services for the Moycullen, Rosscahill and Oughterard area. As I said, I raised this matter more than a year ago with the Minister of State's colleague who was speaking on behalf of the Minister, Deputy Donnelly. This is good value for money and it is an area with a growing population. While they put their own services in place, it is putting a strain and pressure on those doctors who provide a huge service to the general area and who are exceptional in what they do but who, unfortunately, are under pressure. Enhanced GP services for Westdoc, with funding from the HSE, would alleviate much of the pressure they are facing. I look forward to the Minister of State’s reply, which it is hoped will be positive based on the fact that last year the Minister of State, Deputy Butler, said there was an issue and that it seemed strange. Second, Anne O’Connor, director of operations at the HSE stated that funding is available under the winter plan for those areas that would be under pressure. I would expect that the Moycullen, Roscahill and Oughterard area could be looked after with enhanced Westdoc funding.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this issue. General practice is at the heart of primary care, and a robust general practice and GP out-of-hours service is essential to the delivery of primary care health services. As the Senator will be aware, GPs are required under the General Medical Services, GMS, to make suitable arrangements to enable contact to be made with them, or a locum or deputy, for emergencies outside of normal practice hours. Most GPs meet this obligation through GP out-of-hours co-operatives that facilitate the provision of GP services outside of normal surgery hours. The Westdoc co-operative provides out-of-hours GP services in Community Healthcare West, covering counties Galway, Mayo and Roscommon. It is acknowledged, however, that the Westdoc service does not extend to certain rural areas within the region. This mainly refers to GPs in east and west Galway who are not members of Westdoc. The four GPs in Moycullen, Roscahill and Oughterard are not Westdoc members. As such they operate a rota between them in respect of the out-of-hours cover.

While GP out-of-hours co-operatives are private entities, the HSE provides substantial funding to support the out-of-hours co-operatives, covering a wide range of costs. Since the emergence of the Covid-19 pandemic, the HSE has provided out-of-hours co-operatives with a support grant to ensure continuity of care. In addition, the HSE continues to support GP practices and out-of-hours services through the provision of personal protective equipment, PPE, supporting safe service provision in the context of Covid-19. HSE funding for Westdoc is provided through a service level arrangement with HSE Community Healthcare West. In 2021 and 2020, the organisation received approximately €4 million in funding from the HSE. Also in 2018, HSE primary care operations allocated an additional sum of €150,000 for the provision of extra staffing for the Westdoc GP rota to extend weekend cover in north and south Connemara and Achill. However, specific requests for funding for out-of-hours co-operatives must be looked at in the context of the availability of resources and the competing demands for health service funding generally.

The workforce issues facing general practice in certain areas, in particular rural areas, are well recognised by the Government. Rural GMS vacancies can be more difficult to fill as they are often single-handed practices with smaller patient panel sizes, and I thank the Senator for raising that important issue. To increase the number of GPs working nationwide and therefore improve access to GP and out-of-hours services, the Government has increased investment in general practice. Under the 2019 agreement, investment is to increase by 40% or €210 million between 2019 and 2023. Funding has been increased by nearly €144 million up to this year, and an additional €63 million will be provided in budget 2022. For this winter, an additional €10 million in funding is being provided to support general practice nationally, given the extra pressure the winter period can bring, in particular on single-handed practices. The rural practice support introduced previously has been increased under the agreement to support rural GPs and make rural GMS panels more attractive. Improvements to maternity and paternity leave arrangements and a €2 million fund for GPs in disadvantaged urban areas have also been introduced.

The continuing investment in the wider primary care sector will help attract doctors into general practice, as is evident from the increasing numbers of entrants to GP training, from 120 in 2009 to 213 in 2020, with 233 trainees enrolled this year. These actions will help sustain general practice and improve the level of care provided to patients nationwide.

Seán Kyne (Fine Gael)
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I thank the Minister of State for his reply and I received much of that information last year from his colleague, the Minister of State, Deputy Butler, on behalf of the Minister, Deputy Donnelly. The Minister of State said of this winter, "an additional €10 million in funding is being provided to support general practice nationally, given the extra pressure the winter period can bring, in particular on single-handed practices". This is what the director of operations of the HSE, Anne O’Connor, said at the Committee on Health a number of weeks ago. Where will that funding be directed and can it be directed towards enhanced Westdoc services in Moycullen, Roscahill and Oughterard? That is the question I have asked which the Minister of State has not answered today on behalf of the Minister or the HSE. How will this funding be allocated? Who decides?

Galway is under pressure, there is a need for a service and GPs are willing to be part of that service. Funding of €10 million is available nationally. How can that be matched to the local need in the Moycullen, Roscahill and Oughterard area to join with Westdoc? That is the question I am looking for an answer to.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising that question on enhanced Westdoc services in Moycullen, Roscahill and Oughterard. The Senator knows the importance of general practice as part of primary care is evident at this time. GPs are playing a critical role in combating the Covid-19 pandemic, performing additional services while continuing to provide non-Covid care. The commitment of GPs in that area to patient care is laudable and I thank them for that dedication.

GP out-of-hours services are a necessary component of general practice and the HSE provides significant funding. The Senator is asking that, when this funding is issued, his area of Moycullen, Roscahill and Oughterard will be included. I will bring that back to the Minister and we will ask the HSE to do that. It is to be hoped the Senator’s voice will be listened to on this occasion. I thank him again for raising this issue and I hope that in the coming weeks there will be a successful outcome to this.

Garret Ahearn (Fine Gael)
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Senator Ruane has had to withdraw her Commencement matter so we will go to Senator Malcolm Byrne.