David Cullinane (Waterford, Sinn Fein)
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653. To ask the Minister for Health the work which has been conducted in relation to general practice and primary care policy for implementation of Sláintecare; and if he will make a statement on the matter. [4361/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Oireachtas Committee on the Future of Healthcare set out in the Sláintecare Oireachtas Report their vision to deliver safe, quality health and social care services that meets the needs of the growing population. The vision of Sláintecare is to achieve a universal single-tier health and social care system, where everyone has equitable access to services based on need, and not ability to pay.

General practice policies central to the implementation of Sláintecare are the reform of the GMS GP contract and the roll out of a Chronic Disease Management (CDM) programme for GMS patients, and the move towards universal access to GP services without charges on a phased basis. The key primary care policy supporting the implementation of Sláintecare is the development of the Enhanced Community Care programme.

The 2019 GP Agreement helps to modernise and reform the GMS scheme, expanding services for patients and making general practice a more attractive career option for doctors. As part of the agreement, the CDM programme for type 2 diabetes, asthma, COPD, and cardiovascular disease, commenced in 2020 and will be fully rolled out by 2023. The CDM programme aims to bring the care for chronic disease further into the community and reduce hospital attendance by patients with the four conditions.

Furthermore, the Agreement includes a commitment to undertake a strategic review of GP services within the lifetime of the Agreement, to examine how best to ensure the provision of GP services in Ireland for the future. The outcome of this review will inform future contractual changes, with preparatory work for the review having begun this year.

A number of measures have been introduced in recent years to expand access to GP care without charges. For example, since 2015, all children under the age of 6 years and all persons aged 70 and over are now automatically eligible for a GP visit card and since 2018, all those in receipt of either a full or half-rate Carer's Allowance or Carer's Benefit are automatically eligible for a GP visit card. In addition, Budget 2022 provides for the initial stage of the planned expansion of GP care without fees to all children aged 12 years and under, the provision of GP care without fees to all children aged 6 and 7, and work has commenced to roll this service out in the course of 2022.

The Enhanced Community Care (ECC) programme involves the development of new models of care and service delivery, maximising effectiveness and with integration as a core value as identified by Sláintecare.

Service delivery will be re-orientated towards General Practice, primary care and community-based services with CHNs and Community Specialist Teams working in an integrated way with the National Ambulance Service and acute services to deliver end-to-end care, keeping people out of hospital and embracing a ‘home first’ approach. The utilisation of eHealth forms a central part of the ECC programme and is key to supporting integration of services.

The ECC’s various components can be summarised as encompassing six areas of action:

- Establishing CHNs to provide the foundation and organisational structure through which an integrated care system is provided locally based on population need and size.

- Implementing integrated care programmes for older people and chronic disease management;

- Expanding workforce and infrastructure capacity in the community through targeted application of resources to a defined population. The focus will be on implementing best practice models of care to demonstrate the delivery of specific outcomes and sustainable services, which can be scaled for full national implementation;

- Expanding the range of services available in the community;

- Developing working arrangements for staff and contracted professionals to enable the delivery of expanded services;

- Developing an enabling environment for joined-up community working including ICT, data, clinical governance, patient safety and quality operating frameworks and systems.

These policy aims clearly align with the principles set out in the Sláintecare report, as well as with best practice principles enunciated internationally by WHO among others.

David Cullinane (Waterford, Sinn Fein)
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654. To ask the Minister for Health the strategic work which has been conducted to assess and plan for future staffing requirements, workload and demographic pressures in general practice and primary care; and if he will make a statement on the matter. [4362/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Health Service Capacity Review 2018 estimated future capacity requirements in acute hospitals, primary care and in services for older persons (residential and homecare services) for the period to 2031. The analysis took account of current levels of demand and capacity, demographic and non-demographic factors that will drive future demand, and the potential impact that key system reforms can have on capacity needs.

“Projections of Expenditure for Primary, Community and Long-Term Care in Ireland, 2019–2035, based on the Hippocrates Model” (July 2021) a research paper from the ESRI funded by the Department of Health, projects expenditure for most primary, community, and long-term health and social care services in Ireland for the years 2019–2035.

General Practitioners play an important role in the primary care system. Specific to general practice, the HSE National Doctor and Training publication Medical Workforce Planning Future Demand for General Practitioners 2015-2025 noted that to meet the demand for GPs that may be required by 2025, the State would require significant increases to the annual intake for GP postgraduate specialist training.

There has been a significant increase in the number of GPs entering training in recent years, up from 120 in 2009 to 233 in 2021, with large increases made in recent years. Further increases are expected following the transfer of responsibility for training from the HSE to the Irish College of General Practitioners.

The Government has undertaken several other measures to increase the attractiveness of general practice to prospective GPs. Under the 2019 GP Agreement investment in general practice is set to increase by approximately 40% (€210 million) between 2019 and 2023, providing for significant increases in capitation fees for participating GPs. Improvements to maternity and paternity leave arrangements have also been made, and supports introduced for rural practices and practices in areas of urban deprivation.

The 2019 GP Agreement also includes a commitment to undertake a strategic review of GP services within the lifetime of the Agreement, to examine how best to ensure the provision of GP services in Ireland for the future. The outcome of this review will inform future contractual changes.

David Cullinane (Waterford, Sinn Fein)
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655. To ask the Minister for Health the work which has been done on costing options for universal general practice care and public primary care; and if he will make a statement on the matter. [4363/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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GMS contractors receive a range of capitation rates, fee per service payments and practice supports. Extending GP care without charges to all citizens who do not currently hold a medical card or GP visit card would encompass a further 2.92 million people approximately. It is not possible to definitively calculate the cost of universal GP care without charges given the wide range of payments and variables that have to be accounted for.

Such a calculation would require a complex and detailed modelling exercise to account for a range of demographic changes, future projections of service demands and variation in the number of GPs and the allowances that could be paid. 

Additionally, the fees payable to GPs could only be determined following agreement with the IMO on the scope and content of the general practitioner service to be provided, as well as on the future of the various other supports provided to general practice.  However, the 2019 IGEES paper "Costing Framework for the Expansion of GP Care" provides a cost estimate for universal free GP care and is available from igees.gov.ie/wp-content/uploads/2019/10/Costing-Framework-for-the-Expansion-of-GP-Care.pdf.

Over the last number of years, several pieces of detailed policy analysis have been undertaken to assessvarious aspects ofexpanding eligibility for near or full universal access to primary care and other care sectors and the associated additional costs for the Exchequer.  These include the Expert Group Report on Resource Allocation and Financing of the Irish Health System (2010), the White Paper on Universal Health Insurance and Associated Costs (2015) the Committee on the Future of Healthcare Sláintecare Report (2018) and Universal GP Care in Ireland: Potential Cost Implications (2018).

David Cullinane (Waterford, Sinn Fein)
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656. To ask the Minister for Health the compensation options he has explored for incentivising holders of existing consultant contracts to adopt the new Sláintecare public only contract; and if he will make a statement on the matter. [4367/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Government is committed to introducing the Sláintecare Consultant Contract to hospital consultants in our health service at the soonest available opportunity. This Contract remains a key focus of the HSE and my Department, and it is intended that the Contract will be introduced following engagement with the representative bodies, the IMO and the IHCA, a process that is ongoing.

As the talks process has not concluded, it would not be appropriate to make public details about them at this time, save to say that I and my officials remain committed to introducing a new contract as soon as practicable.