Pat Casey (Fianna Fail)
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I welcome the Minister of State at the Department of Health, Deputy Anne Rabbitte, to the Chamber.

Aisling Dolan (Fine Gael)
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I thank the Minister of State for taking the time to be here. She and I attended a meeting on Monday evening in the Shearwater Hotel at which GPs from the Ballinasloe and south-east Galway area came together. They came from group practices, including the Marina House and Dunlo medical centres, which are well known in Ballinasloe town. These cover a huge area, not only of County Galway but also of south County Roscommon because we are right on the county boundary. It includes places like Taghmaconnell, Moore, Aughrim and Clontuskert. We also had GPs representing single practices, including Dr. Mary Murphy from Laurencetown health centre, Dr. Ranga from the Eyrecourt medical centre and Dr. Ferguson from Kiltormer health centre. Kilconnell, where there is a locum and no GP, was also represented.

As the Minister of State will be aware, I and other public representative have raised this matter for the past number of years. The network of GPs in the area provides an excellent service 24 hours per day, 365 days a year. They do night-time and weekend cover. These GPs are suffering, as are patients and families in the region. We have a crisis because people cannot access Westdoc supports. Westdoc, which is co-funded by the HSE, can provide cover and support GP networks all around the county. There are challenging areas, including east and south-east Galway. Portumna, which is in the Minister of State's area, is a big challenge, as is Moycullen. These are areas of the west that face a huge challenge in recruitment and retention. How on earth can we attract quality GPs to start a life, live in our region and perform an invaluable service to our community? The GP is the first point of call for people getting health checks, X-rays or blood tests or dealing with a family crisis. How is the State supporting the GP network in east and south-east Galway? How are we going to recruit? The HSE had to bring a locum into Kilconnell and there are other locums because there are about ten vacancies in the west. These locums are costing approximately €180,000 each.

All of the local public representatives attended the meeting on Monday, as did HSE representatives from Community Healthcare West. I am grateful they were able to attend. They highlighted that the cost of a locum in Kiltormer was €180,000 and that the overall cost of cover with Westdoc was roughly €528,000. The HSE group in the area submitted requests last year and the year before that but no funding is arriving and none has been allocated. GPs in the area are at crisis point. We have heard stories, as has the Minister of State, of GPs working for 40 hours straight. They then have to get into a car and travel. This is putting doctors and patients at risk. There is no EU working time directive for GPs. We need to protect our GPs and ensure they have a good work-life balance. I know the Minister of State has been supportive on this issue. She spoke with the GPs who attended, including Dr. Genevieve Flynn and Dr. Jennings, women who are working in our region. What about bringing in young GPs, including young women GPs with families?How on earth are young GPs, GPs with families, going to support doing a one-in-eight rota and trying to work 13 days in a row? These are doctors who have not taken a break since January and are afraid to bring locums in because, if they do, the locums will not provide the same level of service as they do and how are they going to be responsible for their community? There is a commitment and a diligence to patients in our local area.

I have written a letter to the Minister for Health, Deputy Donnelly. I know the Minister of State has mentioned we might potentially be able to hold a meeting. This is something I have raised over recent years, as have GPs, but we need a solution. Is this going to come out of the winter service plan or from the budget that has been allocated for GP visit cards, where it has been stated there is extra budget for GPs and the GP network? We have expanded the GP cards now to people under the median income from April of next year. Where are the funds with which we can support our GPs right now? I do not want to lose any more GPs in my region and I am responsible for that Ballinasloe to south-east Galway area.

Anne Rabbitte (Galway East, Fianna Fail)
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I am also responsible for the people of south-east Galway, and the Senator is quite right. We attended that meeting the other night and it is important to share here that a selection of GPs from right across the Ballinasloe, Kilconnell, Kiltormer, Eyrecourt, Lawrencetown area were in attendance. There was one outlier, a Dr. Fahey, who came with me came from Portumna to attend. The whole purpose of the meeting was to ensure the creation of a cell in what I would deem technically the Ballinasloe area and to highlight the need for this. As the Senator can see from the response from the Department, no additional funding has been approved to this request. The €528,000 that was sought from the HSE for the creation of this cell has not been approved under the budgetary allocation. I could come to the House and give a very fluffy answer, skirt around the edges and not give it exactly as it is. As it is, no funding in budget 2023 has been allocated for the creation of a new cell in the proposal that has been forwarded by the HSE.

What has been awarded is €2.5 million to the HSE in the west to ensure the continuation of the HSE Westdoc practices currently in operation. That is €2.5 million that is to go all the way across an area that covers CHO 2, which we discussed at length the other night. We saw how much investment was made in 2021 and 2022, but now we have a real figure as to what that comes to. It comes to €2.5 million for Westdoc in our area, but it completely excludes everything from the bridge in Portumna to the bridge in Banagher, all the way to south Roscommon to the areas and the GPs the Senator talks about, including the Ballinasloe area.

What concerns me greatly, and I raised this with the Minister, Deputy Donnelly, is that the GPs in the Ballinasloe area have served notice to withdraw their weekend cover from 1 December. There were very clear about that. If that were to happen, it would be the first time in 50 years that our GPs would have withdrawn from providing a service but also the first time in 50 years they have would terminated themselves out of a contract. They are contracted, of course, but not supported. In fairness to the Minister, Deputy Donnelly, when I met him, he suggested, just as the Senator has, discussing the winter plan to see if there was capacity there to support GPs. To be fair to the Minister as well, I only sprang this on him yesterday. The Senator was very rapid in tabling the Commencement matter, so I have not had the space to have that conversation with the Minister and with my elected representatives from the area who were present the other night. They heard about the very concerning effects this is having on the protection of females within the practices and the out-of-hours services, and the pressure it is putting them under. There is also the health and safety piece but we also have to ensure we can maintain people within the practices and attract people into the practices in the area.

I am confident we will meet the Minister, Deputy Donnelly. We are still trying to figure out his availability. There may even be tonight after the voting block. I am not saying this is definite but we are looking for that space. The Minister has talked to me about the winter plan. There are two parts in this conversation. There is the Ballinasloe set and there is the Portumna piece. The latter is on three borders and the country boundaries of Clare, Tipperary and Galway. To be fair to those in Ballinasloe, they were never part of that arrangement and I do not think they wish to be part of it either, because that would mean Westdoc would be covering from Roscommon town all the way up to Portumna and to Lawrencetown. That is not feasible either if we are to ensure a proper delivery of a Westdoc service. We have a Portumna piece but we also have the creation of a new GP cell in Ballinasloe. When we get to meet the Minister, it is to be hoped we will be able to articulate, as the Senator has put eloquently, the need for representation for our GPs but also the need for the delivery of support in the area.

Aisling Dolan (Fine Gael)
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I know this is not an easy situation but we need that meeting with the Minister, as the Minister of State has mentioned. That has to happen. It is incredible to say we cannot support a network of GPs who are, as the Minister of State said, entering into retirement age and who have no support in place. We cannot talk about legacy issues here because right now we are talking about families and people living in Galway and south Roscommon who will not have access to GP support. They will not have access and yet we are saying we will expand the GP visit card and will have spent the largest ever HSE budget last year and will spend the largest ever this year. Despite this, we will not be doing anything about GPs, Sláintecare or supporting families on the ground, even though GPs are the first point of contact when it comes to medical issues, mental health issues and trying to make sure our families are supported. I am frustrated and I know GPs will be very frustrated with the fact there is nothing in the budget this year to support Westdoc and an expansion of its services. It needs to happen. It is not enough that the HSE has been asking for this and has been putting in submissions year after year for the past five years asking for support and it has not happened. That is not good enough.

Anne Rabbitte (Galway East, Fianna Fail)
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Let us be very clear. The Department funds the HSE. We give the HSE the money and it is up to it to operationalise it. How the HSE decides to do this is out of my control as much as it is out of the control of the Senator. In any case, the HSE get the funds to operationalise it wherever it deems it necessary. The HSE obviously does not deem south-east Galway a priority within its allocation of funding. To get €4 million and not see Ballinasloe as a priority to me is wilful neglect. That is what it is. I call on the HSE to go back to the drawing board and reallocate its funding to see equality for our GPs right across the county, not in particular areas where operational cells are easy to work. Operational cells that are difficult, like those in Ballinasloe, need to be addressed head on. The HSE needs to reprioritise its €4 million because it is not good enough that the likes of a GP in Portumna gets a half day off every weekend. That is not sustainable, it is not good work-life balance and it is not good for their mental health. I will work with the Senator on this.

Aisling Dolan (Fine Gael)
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I thank the Minister of State for her time.