Stephen Donnelly (Wicklow, Fianna Fail)
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GPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.

The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and is working to ensure that general practice is sustainable in all areas into the future.

Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. The Agreement provides for an increase in capitation fees for participating GPs, additional services, improved family arrangements as well as a targeted €2 million fund to support to practices in deprived urban areas.

In addition to the more general measures taken to increase the number of GPs in the State, specific supports are in place to support GPs in rural areas.

The practice support package for rural GP practices which was introduced previously has been increased by 10% under the 2019 GP Agreement. Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking. Specific fees are also in place for dispensing doctors (who operate in rural areas), these have been increased by 28% under the Agreement.

As was announced last week, agreement has been reached with the IMO to extend eligibility for GP visit cards to people who earn up to the median household income and to children aged 6 & 7. This new GP agreement includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP Out of Hours services. A new form of practice grant will also be made available to GPs for additional support staff, in addition to an increase in the existing Practice Support Subsidy. This grant may be shared between practices under certain circumstances.

A ring-fenced fund of €0.6m is being made available to support the delivery of an initiative to support rural GPs, including assistance sourcing locum cover. The HSE will collaborate with the IMO to implement this element of the Agreement.

Furthermore, I recently published the Terms of Reference for a Strategic review of General Practice which will commence shortly and is to be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice including issues around GP capacity, and will set out the measures necessary to deliver a better general practice. The provision of GP services in certain rural and urban deprived areas that are underserved, and the possible mechanisms to attract more GPs to these locations, is a specific issue that will be examined under the review.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for his interest in this important topic. The joint HSE and ICGP Non-EU GP Programme is on target to bring up to 100 non-EU GPs to Ireland in 2023 which will help to quickly improve access to GP services, particularly in areas with limited capacity. It is planned to bring up to 250 more non-EU GPs by the end of 2024.

A Doctor wishing to practice medicine in Ireland must register with the Irish Medical Council (IMC). The IMC, which is the statutory agency responsible for the registration and regulation of doctors in Ireland, has advised that the number of applications from doctors for registration has grown significantly in recent years. The year-to-date number of first-time applications for 2022 and 2023 is approximately double that of the previous 5 years. To protect patients, the Council has a responsibility to ensure that all doctors registered in Ireland meet the requirements to practice medicine, as set out in its legislation. The increase in the number of doctors applying for registration has impacted on the turnaround time for processing relevant applications.

As participating doctors in the scheme under reference qualify outside of the EU, they are not entitled to automatic recognition of their qualifications under the EU Directive 2005/36/EC. These doctors must pass or be exempt from the IMC’s pre-registration exam when applying for General registration. Exemptions can be granted to applicants who have undertaken an internship recognised to be the equivalent of an Irish internship (COE route) or who hold a higher qualification recognised for the purpose of granting an exemption. The turnaround time for the COE route has increased markedly as a result of the increase in numbers of doctors applying for registration with the IMC.

The IMC has advised me that it has commenced a process-improvement initiative to identify solutions to reduce the processing time. The Council is undertaking an in-depth analysis of all the applications routes, reviewing application data, current processes and challenges. They are identifying processes related to turnaround times that need to be improved and identifying solutions for implementation in due course.

Importantly, where the Council is made aware an applicant has a job offer either by an employer or by the doctor, every effort is made to expedite the application to minimise any delay in service delivery.

Stephen Donnelly (Wicklow, Fianna Fail)
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GPs are private practitioners, as such GPs arrange professional indemnity insurance from private medical indemnity providers. This is an arrangement between the two private parties in which the Minister for Health has no role.

The State indemnifies enterprises on behalf of the Minister for Health under the Clinical Indemnity Scheme (CIS) when national policy confirms that this should be provided. As private practitioners, GPs, and the services provided by them and by GP practice nurses, are not covered by the CIS.

Most GPs hold a GMS contract with the HSE for the provision of healthcare services without charge to medical card and GP visit card holders. GPs are remunerated for these services primarily on an annual capitation basis, with a range of additional support payments and fees for specific items of service and some consultation types. Under the GMS scheme a significant contribution is also made towards participating GPs' medical indemnity insurance costs. GPs with a GMS panel of 100 patients or more can apply to the for a partial refund, based on panel size, of their net indemnity insurance cost.