Micheál Carrigy (Fine Gael)
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This matter relates to out-of-hours services at St. Joseph's Hospital, Longford. I will give the Minister of State a little background. In December 2022, the old MIDOC service that was there went into receivership and it left no permanent contract in place for the out-of-hours service, or the red-eye service, for evening and weekend services in Longford. To date, a permanent contract has not been put in place. There were times when the service was not available and people had to travel to Mullingar hospital.We have seen the opening of a minor injury clinic at St. Francis's hospital in Ballinderry, which is on the edge of Mullingar as well, without any investment in the campus at St. Joseph's hospital.

I put on the record my thanks to the Minister, Deputy Harris, when he was Minister for Health. He allocated a multimillion euro fund to upgrade the care centre for the elderly, but the people of Longford want a permanent out-of-hours service contract put in place. We feel not enough investment is going into the centre there. We have been looking for additional palliative beds. We have a fantastic X-ray facility, which needs a significant upgrade, but that investment does not seem to be put in place. My colleague, Councillor Peggy Nolan, has probably been one of the strongest advocates for the staff and, indeed, the service there. I will also highlight this issue. We want a permanent contract put in place, to take away that fear that if an issue arises with regard to the availability of a doctor, we will be left without that service in our county town which means, yet again, we have to travel three quarters of an hour to get that service. I want a commitment from the HSE that service will be in place immediately to serve the people of County Longford.

Thomas Byrne (Meath East, Fianna Fail)
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A robust general practice and GP out-of-hours service is essential to the delivery of our primary care health service. GP out-of-hours co-operatives are largely private organisations. However, since MIDOC out-of-hours ceased operations on 31 December last, the urgent out-of-hours GP service in the area, which was previously run by MIDOC, has been run by the HSE. The service provides out-of-hours GP care for counties Laois, Offaly, Longford and Westmeath. MIDOC GP CLG, a private company, previously co-ordinated the rotas and payments for GPs who worked in the MIDOC out-of-hours service. However, MIDOC made the decision to cease trading on the 31 December 2022. This was despite a long period of prior engagement with the HSE to help address the financial challenges the company faced and financial support to the company provided by the HSE, to allow for the completion of an independent financial review. It was disappointing that despite this ongoing engagement and support, the company ceased trading.

Since December, there has been no change to or cessation of services, as the HSE put in place interim arrangements to provide urgent out-of-hours GP services, including the out-of-hours service at St. Joseph’s hospital in Longford. Since the decision by MIDOC to cease trading, the HSE has been engaging with the Irish Medical Organisation, IMO, and continues to communicate with GPs. The HSE has ensured and will continue to ensure the provision of out-of-hours services until such time as an alternative provider is in place.

It is important to note, however, that the provision of out-of-hours services is a contractual obligation under the general medical scheme contract and, therefore, the decision on who provides the service rests with the GPs. The HSE will support and facilitate this process. The current interim arrangements will continue until at least 2 July 2023, allowing the necessary time for GPs to agree on a preferred out-of-hours provider and to implement the service, which is a contractual obligation under the general medical scheme.

The terms of reference for a strategic review of general practice have recently been published. This review will commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including the out-of-hours services and will set out the measures necessary to deliver a more sustainable general practice.

Micheál Carrigy (Fine Gael)
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The one line that stands out to me again is that the "interim arrangements will continue until at least 2 July". The interim arrangements to get a contract were meant to be until the end of January; then the end of April and now they are until 2 July. I acknowledge the agreement has to come from the doctors, but that is in conjunction with the HSE. This is a priority for us in Longford. It is not good enough for the constituents in my local area to know this is an interim arrangement. It is the only interim arrangement anywhere in the country. We need a permanent arrangement in place. I ask that this be a priority for the senior staff within the HSE and within the community healthcare organisation, CHO. I also highlight a lack of funding for some of the services on that campus. Some of the queues in Mullingar hospital could be alleviated by upgrading, at least, the X-ray service and giving consideration to what is a successful minor injury clinic, based only two or three miles from Mullingar hospital and yet some people in County Longford are more than an hour away from it. Some consideration should be given to a minor injury clinic based at St. Joseph's hospital. It would cut down on the number of people who are going in to the emergency department in Mullingar hospital.

Thomas Byrne (Meath East, Fianna Fail)
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I will take all of that back to the Minister, who is in the Dáil at present. I apologise for that. He is answering questions. A key sentence from what I have already said is that "the HSE has ensured and will continue to ensure the provision of out-of-hours services until such time as an alternative provider is in place". That is very important. It is reassurance for the Senator's constituents in Longford. Despite the decision of the private company MIDOC to cease trading, there has been no disruption to the urgent out-of-hours GP services in the midlands. The HSE has been managing and will continue to manage the provision of out-of-hours urgent GP care in the area previously served by MIDOC. This arrangement will remain in place until an alternative provider is agreed by local GPs and is put in place. The HSE continues to support out-of-hours services throughout the country and provide significant financial supports towards service delivery. It regularly engages with all providers and recently increased the funding and supports available to them over the busy winter period, to allow the rostering of more doctors in order that more patients are seen. Senator Carrigy can be assured that quality and patient safety in the delivery of out-of-hours GP care remains paramount for the HSE.