Seanad debates
Wednesday, 7 February 2024
Nithe i dtosach suíonna - Commencement Matters
General Practitioner Services
1:00 pm
John Cummins (Fine Gael)
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I echo the Acting Chair’s comments wishing Senator Craughwell’s daughter the very best.
This is an important Commencement matter. I thank the Cathaoirleach for selecting it. I put it on the agenda for last week but time did not allow for it.
I thank the Minister of State for joining us in the House for this debate. I acknowledge the lack of rural GPs is not specifically in her remit but it affects many older persons who I am sure are often in contact with her good offices also. The lack of GPs in rural areas in particular is increasingly becoming an issue as older GPs retire and there simply are not enough new GPs coming through our universities and being recruited into the country, despite the fact that we have had quite a significant increase in both of those tranches in recent years.
The result means that places like Lismore in the Minister of State’s and my county of Waterford are without a permanent GP since the previous one retired in September of last year. While there has been various locums in place over the intervening period, the lack of continuity of care is leading to serious issues for residents in the area. Thankfully, there is a new GP practice in Tallow to add to the existing one there, which has eased the burden. As the Minister of State knows, it is only about a ten-minute drive from Lismore and it is on a good Local Link service. However, we need to have a fully functioning and permanent GP practice operating in Lismore.
In delving into this issue in recent times and from receiving calls from people, it has become apparent that the freezing of that list has become more and more of a problem, particularly for people who need that continuity of care. To give the Minister of State a flavour of the calls we have been receiving in the Dungarvan and Waterford city offices, one lady who spoke to my staff last week was upset and explained that she had ongoing female health issues that required continuity of care. She had actually stopped going to the GP to have her symptoms treated because she had to continually explain her problems from scratch to several new male GP locums over the past number of months. She applied to the HSE to have the ability to move to that new GP practice and was refused. What, if any, criteria are being used to determine whether a patient can move from a frozen list? In a recent reply I received from the HSE, the rationale cited on freezing the GMS list is to ensure there is a viable panel to attract a candidate when the post is re-advertised. I understand that is due to happen again this month. There have been two previous attempts but, unfortunately, we do not have a permanent GP in place. While there absolutely is merit in ensuring that there is a viable list in place, there has to be some common sense applied in the case where continuity of care is needed.
I have another constituent who actually lives closer to Tallow than Lismore.
Surely geography is something that should be a consideration in determining that.
While I understand that there is a bigger picture here with regard to recruitment, retention and attracting more GPs into rural areas, there have to be instances where common sense is applied. I am just looking for direction on that from the Minister of State.
Mary Butler (Waterford, Fianna Fail)
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If the Acting Chair might indulge me at the start, I wish to say the following. I know Senators will all join me as today, we think of former Taoiseach John Bruton's wife Finola, his family, colleagues, friends and those in the Fine Gael Party. Like anyone who was Taoiseach in our Parliament over the past 100 years, it is important to send that message out to his family today.
Martin Conway (Fine Gael)
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I thank the Minister of State, and we all very much agree. At 2.30 p.m. today, the House is paying tribute to the former Taoiseach, as is the Dáil. The Minister of State's kind comments are much appreciated, and I know the Bruton family will appreciate them as well.
Mary Butler (Waterford, Fianna Fail)
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I thank Senator Cummins for raising this issue. It is something I am very familiar with myself. We come from the same constituency.
As the Senator is aware, GPs are self-employed practitioners, and accordingly, they may establish practices at a place of their own choosing. The HSE fulfils its obligation under the Health Act 1970 in providing GP services to patients who hold a medical card or GP visit card through the GMS service. Most GPs, over 2,500 of them, hold a GMS contract to provide this service. The HSE becomes actively involved in the recruitment of a replacement GP when a GMS vacancy arises. While the campaign is ongoing, a locum doctor or other interim arrangement is put in place to provide care to the patients on the GMS panel concerned.
As a result of HSE recruitment, the number of GMS GP vacancies has fallen from 34 in April 2023 to 23 last November, and it has remained at 23 since, less than 1% of the total number of GMS panels. Five of the vacancies filled were long-term vacancies that were vacant for over 12 months. With regard to the vacancy in Lismore, the HSE has advised that a full-time GP service continues to be provided, maintaining the integrity of the vacant GMS panel of 861 patients. When previously advertised, a successful candidate chose not to take up the vacant position. The Lismore vacancy will be readvertised this month with the aim of securing a permanent GP as soon as possible. I take on board the points the Senator has made, especially with regard to the two cases he referenced. One was about a person who has specific needs, and how she would like to deal with a female doctor - I can understand that - and the other was about somebody who was living closer to the Tallow area. Unfortunately, the job was advertised. It was accepted, and then for reasons unknown the person did not take up the position, which anybody is entitled to do, so it is being readvertised.
With regard to the HSE and working with them on other similar cases, it works very hard to get a GP into a practice where there is a GMS list. While that is ongoing, the GMS list is frozen, which is standard practice. If the list is not frozen and patients move to other doctors who might have availability or room on their list, what happens then is that if a GP is looking and the list is being depleted, they might not apply for the job. That is normal procedure, where a GMS panel is frozen prior to the post becoming vacant and for up to three months after the vacant post has been filled. When the vacant post is filled, after three months the panel opens again and then people have the opportunity, if they wish and another doctor has availability, to move.
While the HSE may move a GMS patient from a frozen panel, each request is examined individually and patients are only moved under extenuating circumstances. One can apply to be removed from the list. This helps to ensure that the vacant panel does not diminish, remains viable and is still attractive to entice a new GP to apply for the position permanently. It is important to note that for the two cases the Senator mentioned, they can apply to be moved from a frozen list, and each case is looked at on a case-by-case basis.
John Cummins (Fine Gael)
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I thank the Minister of State for her reply. I am going to hone in on those two cases. There are other cases that I have but I specifically picked those ones because in my view, there are extenuating circumstances in both that have been assessed by the HSE.In both instances, there was an application to move and, in both cases, the application was refused. The wrong decision was made but there seems to be no ability to appeal such decisions. I asked for clarity as to what criteria are being used. If geography and the ability to access continuity of care from a female GP for female health issues are not two of those criteria, I do not know what is an acceptable criterion. I ask that common sense be applied in these cases. We have submitted the details of both to the HSE for reconsideration and I hope that is done.
Mary Butler (Waterford, Fianna Fail)
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I will follow up on those two cases. I agree there must be a common-sense approach and that people must have options. When a list is frozen, which happens for a myriad of reasons, people may not be in a position to move. Health issues are challenging enough without causing further distress to people.
The number of doctors entering GP training has increased by 80% between 2015 and 2023. The availability of 350 training places for new entrants is planned for this year, representing a 22% increase on last year's intake of 286. That is really important. The HSE has made great progress in filling GMS GP vacancies since last year's high of 34, with the number now down to 23. The HSE will continue to work on the issue and I will keep a close eye on it. I have been consulted by several constituents regarding the vacancy in Lismore, which, unfortunately, was not filled after previously being advertised. I understand how difficult the situation is for certain patients.