Martin Conway (Fine Gael)
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I welcome the Minister of State back to the House and thank her for taking this Commencement matter. Shannondoc is a community healthcare service, a co-operative of doctors as it were, in the mid-west region to provide out-of-hours service. We can recall how years ago, doctors were on call all the time. It could be 6 p.m. or 8 p.m. it did not matter; doctors were still on call. In order to give doctors a quality of life and to improve the quality of service, and to ensure that there was a service, the doctors came together and created Shannondoc. That has been emulated around the country. To be fair, the Governments stood up to the plate and did provide resources to support the community out-of-hours doctors initiatives around the country. However, while in some areas they have worked extremely well, in others they have been average or extremely poor.

The experience of Shannondoc in my area has been mixed. The doctors who work in it when they are available are very committed and do a very good job. They can take the pressure off our emergency departments. The problem is that the Shannondoc service has been consolidated and it has been curtailed and cut back to such a degree that there are real challenges to the provision of services. There was a time when there was a Shannondoc facility just outside the towns of Ennistymon and of Kilrush and in other areas. However that has been consolidated and I believe that Miltown Malbay is the only facility that Shannondoc is providing in west Clare. That is a challenge.

There has been Covid and other things but the Minister of State will be very aware of the enormous challenges to the emergency department in University Hospital Limerick, UHL. It is the most overcrowded emergency department in the country. It regularly has 90 to 100 people on trolleys. Many, or at least some of them could be diverted from hospital if they were to present to a Shannondoc-type facility. We have minor incident clinics in places such as Ennis and Nenagh and so on but they close at 8 p.m. If somebody is injured after 8 p.m., it may not be life threatening but if it is something the person is concerned about, in the absence of a Shannondoc facility his or her natural reaction is to go to the emergency department in UHL. That is adding to the numbers. I know that a review of the Shannondoc out-of-hours service has been committed to. I also understand that there may be a national review on the out-of-hours service. The point is about whether we believe in primary care and in trying to care for people within their community as a first response. It may be that people need to attend an emergency department or hospital but the people at primary care level can make the decision that their care must be escalated but in many cases, they can deal with the injury at local level. The out-of-hours doctor service is a critical component of such a service. When someone is injured late at night, they can panic and worry. They may be over-panicked or worried. The out-of-hours doctor service is one which can give them reassurance and provide necessary medical interventions and maybe calm the situation, ensuring that people do not present at the emergency department's front door in Limerick. We want to avoid that where possible.

Is the review happening or has it happened? If not, when will it happen and what is the timeline for a report and recommendations for how we can improve the out-of-hours GP service?

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Conway for raising this issue as GP out-of-hour co-operatives are essential to the delivery of primary care health services. I thank the Senator for continuing to raise health issues in his own area in a constructive way.

As he will be aware, GPs are required under the General Medical Services scheme 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.

Shannondoc out-of-hours co-operative provides urgent GP services to patients in the mid-west region, including Limerick, north Tipperary and Clare. While GP out-of-hours co-operatives are private entities, the HSE provides substantial funding to support co-operatives through service level agreements covering a wide range of costs. Last year, the HSE provided over €5 million in funding for Shannondoc GP out-of-hours co-operative.

The HSE maintains regular contact with the co-operatives to help optimise out-of-hour service levels. Even greater engagement was undertaken to ensure that the services continued to provide the supports needed by local communities during the Covid pandemic. Since the emergence of the Covid-19 virus, the HSE provided out-of-hours co-operatives with a support grant to ensure continuity of care. Funding for Shannondoc was increased to over €6.8 million in 2020, including increased funding due to the pandemic.

Where there is increased demand in certain areas, Shannondoc can provide support from other treatment centres, to ensure services are provided where needed most. The service is demand led, and the HSE has advised that Shannondoc has continued to meet the targets for urgent and routine calls set out under its service level agreement. More generally, the Government is committed to increasing the number of GPs working nationwide and therefore improving access to GP and GP out-of-hours services across the country.

Under the 2019 agreement, investment in general practice is to increase by 40% between 2019 and 2023. Expenditure has already been increased to date by €206.6 million annually, increasing to €211.6 million per annum next year when the agreement is fully rolled out. This provides for significant increases in capitation fees for participating GPs, as well as new fees and subsidies for additional services.

The agreement also provides for improvements to maternity and paternity leave arrangements, introduces a €2 million support fund for GPs in areas of urban deprivation and increases the existing support funding for rural GP practices. The increased investment provided will increase the number of GPs working in the State and will help sustain general practice nationwide, both GP practices and out-of-hour services. The positive impact of the measures undertaken by the Government is evident from the increasing numbers of entrants to GP training, from 120 in 2009 to 233 trainees enrolled last year and 258 places will be made available this year. That is something I know everyone will welcome. The 2019 GP agreement includes a commitment to undertake a strategic review of GP services to examine how best to ensure the sustainable provision of those services into the future. The sustainability of services is what we all want. The review will encompass a broad range of issues, including examining how best to provide for GP out-of-hours care, and will include consultations with relevant key stakeholders. The Department of Health is engaged in the preparatory work for the review which, once completed, will inform future contractual changes. I am sure the Senator will agree that over the past two years, between Covid and the cyberattack, a lot of time was lost. This review is very important and is a commitment under the 2019 agreement with GPs.

Martin Conway (Fine Gael)
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I again thank the Minister of State for coming to the Chamber with a logical answer to an important question. Of course, Covid has been a problem and much healthcare ended up being stalled because of it. Progress, and the incremental progress we like to see, has been challenged. The problem with Shannondoc is that on many occasions there has been no cover. That was simply down to the fact that GPs could not be got and were not available, as was the case for locums and so on. That is always a problem because the public need to have confidence that once GPs sign off on their practices, surgeries and so on, the Shannondoc out-of-hours co-operative service will kick in.

A review is good, and it should happen because it will consider the lessons where things have been done right and identify the gaps where improvements can be made. I see a review as positive and a way of incrementally improving the service as opposed to anything negative, or something the HSE or those in the services should be concerned about.

Mary Butler (Waterford, Fianna Fail)
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I agree with the Senator that a review is a good thing. The provision of out-of-hours GP services will be examined as part of a wider strategic review of general practice for which preparatory work has commenced this year. That is welcome. I note the Senator's point that there have been situations where cover has not always been available. The agreement provides an initial €2 million support fund for GPs in areas of urban deprivation and increases the existing support funding for rural GP practices. The improvements to maternity and paternity leave arrangements are also very important for practices where there might only be one doctor. It can be very challenging if they are on maternity leave or, for example, they are out sick and it is difficult to get a locum. We await the results of the review with interest. I again thank the Senator for raising the matter.