Fiona O'Loughlin (Fianna Fail)
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I thank the Minister of State for being here to answer this question.

My query relates to Ballymore Eustace, a beautiful small town in County Kildare between Naas and Blessington. It has a population of 1,700 people and is growing all the time. In fact, it has the highest number of older people in Kildare, according to the most recent census. The issue I raise relates to the lack of adequate GP clinics. There was a full-time clinic in Ballymore Eustace and about 15 years ago, a GP based in Blessington, whose name I will not mention, took over the practice.

Initially, the agreement was that there would be four clinics a week in the HSE premises and that, therefore, the local population would miss one day. Over the first summer, however, without any consultation with the HSE or the local people, that was cut to two clinics, on Mondays and Tuesdays. Given that on bank holiday Mondays, the practice would not open, that meant there was a service of just one clinic morning a week, which is totally inadequate. The practice was trying to encourage everyone from Ballymore Eustace to go to Blessington, which is a distance away with poor public transport, and for people who did not or could not drive, it was a huge inconvenience.

A number people got together to organise a protest and to lobby on this. Rose Barrett O'Donoghue, a good friend of mind and somebody who is always to the forefront of trying to do what is right for Ballymore Eustace, spearheaded that, along with Muriel Maguire and the late Bernie Toomey. Eventually, they got another clinic, which meant there were three clinics a week, but given that one was held on Thursdays when the pharmacy was closed, it caused difficulties for people who attended the clinic and needed to get prescriptions. Covid-19 then came along and there was nothing for two years, including vaccinations. A doctor from Naas approached the HSE about coming, using the extra times and being able to give vaccinations, and the local population were delighted that this could happen. On the agreed day, however, when the doctor went to the clinic, the locks had been changed and the HSE said that it could not happen.

Eventually, after two years, here we are back down to two days on Mondays and Tuesdays . I feel very strongly about this issue and I recently met with Margaret Pearce and with Rose in that regard. A doctor is prepared to go in and give a full service in Ballymore Eustace but is precluded from doing so.The fact that there are only two clinics per week, and on some weeks only one, means the population, which is growing, is not served. I feel strongly that the Minister of State is in a position to help deal with this and ensure the people of Ballymore Eustace get the full-time GP practice they need and deserve.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Senator O'Loughlin for raising this matter. I am responding to this Commencement matter on behalf of my colleague, the Minister for Health, Deputy Jennifer Carroll MacNeill.

General practitioners are a vital part of our health service, providing care to patients throughout their lives as well as providing patients with access to the wider health service. GPs are private practitioners. The HSE contracts GPs to provide medical services and most GPs - currently over 2,550 - hold a General Medical Services, GMS, contract to provide GP services without charge to medical card and GP visit card holders. Accordingly, as self-employed practitioners, GPs themselves, rather than the HSE, choose where they establish their practices.

At present, the HSE advises that a GP primarily located in the Blessington practice provides a service in Ballymore Eustace two mornings a week, with additional emergency appointments provided there as required and appointments also available at the Blessington practice. It is understood the GP has capacity on those mornings to provide same-day appointments.

Senator O'Loughlin provided further information, which I will bring to the Minister. I am uncertain whether the Senator has had meetings with the HSE locally. I suggest she follow up directly with the Minister by communicating with her, in writing, the additional points she raised.

It is acknowledged that there is a need to increase the number of GP practices across the country to improve access to GP services. To this end, several measures have been undertaken in recent years to increase our GP workforce. Investment in general practice was increased by over €210 million per annum under the 2019 GP agreement, providing for increased GP payments, increased support for practices and new services. The 2023 agreement further increased investment, increasing GP payments again and providing €30 million specifically for new and increased practice supports.

According to the Irish College of General Practitioners, it has received almost 1,800 applications for the 2025 GP training programme. This is more than in any previous year and beats the previous record set the previous year. This reflects positively on the steps taken to increase the attraction of general practice as a career. The number of doctors entering GP training increased by 80% between 2019 and 2024. From 2024 onwards, 350 new-entrant training places have been made available, with 346 new entrants to GP training last year, a 21% increase on the previous year’s intake of 286. The number of GPs graduating has increased in recent years and will further increase significantly in the coming years due to the increased number of new entrants.

In addition, recruitment of GPs from abroad continues under the international medical graduate, IMG, rural GP programme. As of November last year, 119 IMG GPs were in practice and funding has been provided to recruit up to 250 more GPs into Ireland this year. Placement of these GPs is targeted at rural and deprived urban areas.

It should be mentioned that there are significant supports in place for practices in rural areas. These supports were increased under the 2019 GP agreement. Furthermore, a strategic review of general practice is under way which is examining issues related to GP capacity. It will specifically consider possible mechanisms to attract more GPs to rural and under-served areas. When completed, a report will be presented to the Minister for Health containing recommended actions for a more sustainable general practice across the country.

While a GP cannot be directed to open a practice in Ballymore Eustace, increasing our GP workforce should see access to GP services improved for all patients, including those in the area in question and surrounding areas.

I ask Senator O'Loughlin to elaborate on the chronology regarding the provision of GP services in Ballymore Eustace to give some further context. I will respond and perhaps the Senator will then follow up with the Minister.

Fiona O'Loughlin (Fianna Fail)
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I thank the Minister of State for his response. He stated that additional emergency appointments are provided in Ballymore Eustace as required, with appointments also available at the Blessington practice. My understanding is that additional emergency appointments are not being given.There are no same-day appointments in the Blessington practice. Some people have had to wait weeks for that. I appreciate there are some areas where there is a shortage of available GPs. The Minister of State's response was that while a GP cannot be directed to open a practice in Ballymore Eustace, there is a GP who wants to do that. I question how one GP can hold on to a contract that has been reduced from four clinics to two, with one of them on a Monday. That is absolutely wrong. It is being ignored by the HSE. That practice is just driving the practice into Blessington. Many people I know in Ballymore Eustace are using Vista and out-of-hours services, so something is wrong. I will respond with an email to the Minister and copy the Minister of State on it. I will also contact the HSE directly. I thought it was important enough to bring up as a Commencement matter here.

Kieran O'Donnell (Limerick City, Fine Gael)
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Once again I thank Senator O'Loughlin for raising this important issue. As mentioned, GPs are self-employed practitioners and cannot be directed to open a practice in a particular area. Several measures have been taken in recent years, however, to increase GP capacity and improve access to services. The increased investment in general practice under both the 2019 and 2023 GP agreements means improved fees and supports to attract more doctors into general practice. The positive impact of this is being seen in the increased number of doctors applying for and undertaking GP training and the number of applications received this year. The increased availability of GP training places will see the number of GP graduates continue to increase over the coming years. The Department of Health previously estimated that, from 2023 to 2027, between 1.5 and 3 GPs will be on board for every expected GP retirement. The ongoing recruitment of GPs under the international medical graduate programme is placing GPs in deprived areas and rapidly increasing access to GPs in those areas.

In terms of the context of the matters and the particular point the Senator raises, an email from her to the Minister and following up with the HSE is the way to further address this matter.

Imelda Goldsboro (Fianna Fail)
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I thank the Minister of State. I welcome guests in the Gallery. From Conradh na Gaeilge we have Julian de Spáinn and Kate Ní Dhúbhlaoich as well as príomhoide Ghaelscoil Eoin, Cristín Ní Chairealláin and Karen Hinkson-Deeney, a fifth-class parent. We welcome them here.