Jerry Buttimer (Fine Gael)
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I welcome the Minister of State, Deputy Mary Butler.

Victor Boyhan (Independent)
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I thank the Cathaoirleach for selecting this important Commencement matter. I also welcome the Minister of State to the House. This is a very simple Commencement matter to ask the Minister to put in place the provisions for the retention of GP services to ensure that the citizens would have access to an appropriate level of GP care in clinics within the communities of Lucan and Adamstown. That is the critical ask. I am raising this on behalf of Councillor Liona O'Toole who has been a councillor there for many years. She is at the coalface in this community and knows the challenges. For those who may not know Lucan and Adamstown well, these are two of the largest strategic development zones within the country. There is rapid expansion of houses, which is great and all very positive.If we are going to put in houses and build and establish communities, it is important that we have the necessary infrastructure including education, childcare, policing and health. Health is critical to all of this. I also acknowledge the importance of the new primary care centres across the country. The Minister of State will be very familiar with them and knows the benefits of them. That is the route we should be going. I am also conscious that the Minister and the Government are not responsible for the day-to-day care services or where a GP decides to locate a clinic. That is an issue for the services and that is the nature of the systems we have in Ireland. There are plans for reform of community care generally in terms of Sláintecare.

As I said, the two areas are part of a strategic development zone. It is a very fast-growing area. I am hearing from Councillor O'Toole that in Lucan and Adamstown, there are people who have been in the community for two or three years and are still travelling to their original family GPs in Meath, other parts of Dublin, Wicklow and Kildare. They have gone to the local GPs and public clinics and been told they are full or do not have the capacity to take on new patients. That is a big problem.

There is a conference in Dublin today about the retention of GPs. I would have loved to have been there. I think it is in the National Conference Centre. One of the challenges there is how we can retain GPs in our communities, be they urban or rural. There is choice and we cannot compel people, but in the public system, under the GMS contract, we should be able to frame our contracts in terms of commitment to communities and identifying deficits. That is for another day, it is not what my Commencement Matter is about. My Commencement Matter is to try to ascertain what commitments the Minister for Health is putting in place to ensure that the people of Lucan and Adamstown can have an adequate GP service. It is vital. Without it, they cannot have further referrals or exploration of issues. Some people are not availing of essential GP interventions or referrals to specialists because they cannot get that relationship. The Minister of State and I know the importance of having the opportunity to develop a close relationship about your health with your local GP. The issue is Adamstown and Lucan, and how we can address the deficits in the health services locally.

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator for raising this important issue. His question goes to the heart of Sláintecare, the right care at the right time as close to home as possible. As the Senator is aware, GPs are self-employed practitioners, most of whom hold a GMS contract for the provision of services without charge to medical card and GP visit card holders. While the HSE provides significant practices grants to GPs under the GMS scheme, GPs themselves as private practitioners choose where they establish their practices. Where a GMS vacancy does arise, the HSE carries out recruitment campaigns to find a suitable replacement. When a campaign is ongoing, locum arrangements are put in place to provide care to the patients on the GMS panel concerned.

As of 1 September, there is one vacant GMS panel in the Lucan area. Happily, a recruitment campaign to find a GP has been completed and the vacancy has been offered to a successful candidate. That is indeed good news. There will then be 12 contracted GPs with GMS panels in the Lucan area, including the GP who was recently recruited.

It is acknowledged that there are workforce challenges facing general practice, as the Senator has said, and that these challenges limit access to GP services in certain areas and can impact on the timely provision of care. The Government is actively working to increase the number of GPs practising in the State and thereby to improve access to GP services all over the country. Measures have been undertaken by the Minister, Deputy Stephen Donnelly, to increase the attractiveness of working as a GP in Ireland, successive increases have been made to the number of GP trainees, and a joint HSE ICGP programme is recruiting GPs from abroad to support rural and under-served areas. The Government has increased investment in general practice by €211.6 million per annum under the 2019 GP agreement, providing increased GP capitation rates, increased supports and new services. The recent GP agreement 2023 has further increased this level of investment, with further increases to capitation rates and €30 million specifically provided for new and increased practice supports.As per the ICGP, 1,311 medical graduates applied for GP training in 2024. More applied for GP training this year than in any other previous year, which is welcome and reflects positively on the steps taken to increase interest in general practice as a career in Ireland. The number of doctors entering GP training has increased by 80% over the past five years. This year, 347 new entrants commenced GP training, a 21% increase on last year's intake, and the Government is committed to maintaining 350 places annually for the GP training programme.

Under the previously mentioned joint HSE-ICGP programme, the international medical graduate rural GP programme, 121 GPs from abroad were recruited in 2023. Resources have been provided to recruit up to 250 more GPs from outside Ireland this year, the placement of whom is targeted to rural and underserved areas.

A strategic review of general practice is under way. When completed, the review will report on the measures necessary to deliver a more sustainable general practice into the future. GP capacity and the possible methods to attract more GPs to underserved areas is a specific issue being examined under the review. It is important to note that the population has grown exponentially in the last five years and is ageing, which are factors with regard to the issues the Senator has raised.

Victor Boyhan (Independent)
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I thank the Minister of State. I will make two points. First, Lucan is a vast area and one of the fastest growing in the entire country. We are now being told it will have an additional one GP and it is only said this post has been offered, not that it has been accepted, although we take it that the person is accepting it. That means there will be 12 GMS doctors for Lucan. Clearly, this will be an issue at the doors in the forthcoming general election. I do not represent Lucan but I know people who do. There is a problem all over the country but today's matter is about Lucan and Adamstown. Twelve GPs are clearly not enough to serve the GMS system in Lucan.

I welcome the strategic review, which is important, but it should come faster. The Government is completing 4.5 years of its cycle and we are now talking about a review. At the end of the day, people want and should have a good GMS public health system. I welcome the review and we will just have to wait for it. I thank the Minister of State for her comprehensive response to the Commencement matter.

Mary Butler (Waterford, Fianna Fail)
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The Government is working to ensure general practice is sustainable in all areas in the future. The Senator mentioned that we are 4.5 years into the term of the Government, which we are, but the number of doctors entering GP training has increased by 80% in the past five years, which has to be acknowledged. This year, 347 new entrants commenced GP training, a 21% increase on last year’s intake, so we have certainly turned a corner. As a result of this significant increase in GP training places, the Department of Health has estimated that between 1.5 and three new GPs will enter practice for every expected GP retirement in the coming years. One of the issues is that not all GPs want to take on a practice and instead want to work in a practice, and the review will look at that specific issue. I again thank the Senator for raising this important question.