Martin Daly: Questions Minister on New GP Contract and Access

I just asked the Minister her plans for a new GP contract and the progress on the strategic review of general practice in the context of our growing population, the increasing expectations and demands of our health service, the increasing expense of secondary and tertiary care, the need to long-term aim to treat patients with the least complex problems in the most appropriate settings, and that is in a primary care setting by GPs, supported by full primary care teams. Thank you. Minister. Thank you. I would like to assure the Deputies that the Government is committed to continued development of our general practice service and improving GP access to services all around the country. Over €340 million in additional annual investment in general practice has been provided under the 2019 and 2023 GPGMS agreements, and those agreements provide for increased GP capitation fees, increased in new supports for practices, as well as new fees for additional services. So by any measure, that is a considerable support provided by the State, by the taxpayer, to what are private practices? To what are private practices? And it is important to remember that. We are seeing positive impact of that investment, seen in the increased number of doctors both applying for and undertaking GP training. Annual intake into the GP training scheme has increased by 80% from 2019 to 2024, and we have further increased the number of new entrant places this year by 50 to 400. In addition, recruitment of GPs from abroad continues under the International Medical Graduate Rural GP programme, which targets the placement of GPs to rural and underserved areas. In respect of the strategic review of general practice, examining the range of issues affecting general practice is underway and will be completed this year. The review is examining the issues affecting general practice, including issues related to capacity, and will consider further possible mechanisms to attract GPs to rural and underserved areas. When completed, the review will set out recommended actions for more sustainable general practice service delivery for the whole community. While the existing GMS GP contract has been significantly updated and via circular a new approach must also be developed and the strategic review will identify the arrangements necessary to improve our current system of GP care and that will determine any changes required in a new contract. I do want to say that this hugely significant investment in GPs, particularly in chronic disease management, has been of real benefit to the broader healthcare system. The chronic disease management programme in particular, where the state has invested in this, in GP services for the benefit of people at that particular age who may have faced chronic diseases, is really showing dividends both in terms of patient care, in terms of the number of exacerbations, presentations to acute hospitals. So people are living better with chronic diseases because of our investment in GPs and because they can access that more easily. I do have a concern that there is not the same availability of out-of-hours GP in the same way across all of the different regions, and that is creating additional pressures on our emergency department's local injury units, particularly at the time of a rising population. I am conscious of that, particularly in the Midwest and the Southwest, but it is a national profile and that is something that I need to make sure is included in any new contract. I do have a number of other reflections about maximising the use of GP services so that we are getting the best in the community and reducing hospital presentations. I think it is also important to say that our development of pharmacy contracts enables better access to GPs. So the fact now that you can go to the pharmacy, and let me say it loudly again, you do not need to go to your GP for eight conditions, a simple eye infection, a thrush, a urine retract infection. You do not need to go to the GP. You can go directly to your pharmacy and pay 30 euros for a consultation with the pharmacist, a diagnosis and a prescription, and you need never go to two different places. You can go to the pharmacy. Who does that matter for? Everybody. It matters because it creates more space than the GP practices from somebody who needs to go to get a prescription for a urine retract infection. But if you are an older lady, a urine retract infection is a really serious, serious thing that can get much worse and result in hospitalisation. Because we have changed this pathway, you can get quicker diagnosis and an appropriate prescription to clear up a basic but important and potentially risky infection. And in all of those different ways, we try to expand access to appropriate medical care. Deputy Daly, you have a minute, and then Deputy O'Shea, you have a minute. Deputy Daly. Thank you for your answer. Firstly, they are private practices, but the state has chosen to operate a contract for service. And that has suited the state very well over the last number of years. In terms of out of hours, you're absolutely right. If you have a GMS contract, you're obliged to be available and provide an out of hours service. Many younger GPs are choosing not to sign GMS contracts with the state because of that obligation. And I agree with you 100%. We really need to rethink the out of hours framework. And it may well need to be separate from the GP contract because an increasingly older population of GPs are carrying that out of hours burden. In terms of premises, we really do need to rethink the premises. We are relying on a private developer model that hasn't worked in many rural areas or inner city areas where we need to have state-led HSE-built premises. And I would say rent-free for GPs to attract them into those areas. And finally, public salary GPs in some remote rural areas and in deprived urban areas. Thank you. Thank you. I find myself in agreement with all of the five points that Deputy Daly made, such that I don't believe it's necessary to repeat them and look forward to working with you on the very practical points that you have made there, particularly in relation to the out of hours framework, the premises structure and what we might do and how we might think about that and how the development of that in terms of a tax-efficient way of encouraging activity. Because you do correctly recognise this public-private element to it, I must also recognise it from the perspective of the taxpayer and I think that's reasonably fair. But I don't see the need to repeat all of those things that I already agree with you, but I do look forward to your input and how we improve them and thank you for that. In relation to Cork, may I say that while there are no GMS general practitioner posts vacant in County Cork, I do understand, for example, in the area that you represent and in Charleville in particular, for example, that there is a practice that's going from three GPs to two GPs. And the impact that that has on your community is so hugely significant and it shouldn't be understated. And while it's one GP, that's what matters. That's the hours that are available. That's the support that's there to the community. And I really do recognise the point that you are making and I know that HSE officials are continuing to engage with you on that on behalf of your representation for your community. In relation to your query, in relation to the orthodontic service in Cork, there are four retired clinicians. It is anticipated that the whole-time equivalent of specialist orthodontist will reduce to 2.83 from May 2026. And that is on foot. There's been three clinical staff retiring from duty and that has a big impact. Plans to restore the whole-time equivalent levels of specialist orthodontist and senior surgeon posts are being advanced and finalised in HSE Southwest. And in terms of any anticipated retirements for this year, we haven't received any indication of retirement from the remaining clinicians. But we do have a specialist orthodontist on periods of six leave, which is impacting further delivery. And we had a conversation about the importance of that earlier. Thank you. Thank you for raising it. Deputy Daly of one minute and Deputy O'Shea Hill of one minute. Deputy Daly of one minute. Just to acknowledge the investment of the state in general practitioner service over the last number of years, but I think you'd recognise, Minister, that with our growing population, 90,000 a year, the increased expectation and sophistication of our population in what they want from a functioning health service has increased. And I just feel we're not accelerating the capacity at the rate that we're going to have to. We're talking about having probably 6,000 GPs in 15 years' time in order to meet that demand. We have 4,200 GPs who are registered as GPs, but they're not whole-time equivalents. Many of them are in part-time practice. That's just the changing way that people work. Now, younger doctors work in that. So we need to find a way of getting full contribution of the GP trainings that the state has invested huge amounts of money in to get them invested into general practitioner services in the country so that it can be sustainable into the future. Well, that may be very clear in relation to the recruitment. Any delay should only be in actually finding the consultant orthodontist and bringing them into the system. And that does take time because people have to leave posts and so on. But there shouldn't be any delay at a HSE level recognising the level of need that I've described to you, but I've also described more broadly. In relation to GPs generally, look, we have expanded the training programmes and the numbers again and again and again, and we do want them to work. We can't force them to work as GPs in Ireland. We can't force them to work in the public health system. But of course, that is what we want. And again, I think it's time to reflect on the level of investment that we put into training medical practitioners on behalf of the state. It is such a privilege to be able to do that and not charge the fees that would be equivalent in any other country to train as a medical practitioner and the opportunity that gives people. But a bit like we spoke about with dentists and spending a period of time in the public system, we want to develop a cohort of public GPs. There is no question about that. And we have to think about the ways in which we give people the opportunity or the requirement to spend time in the public service to get the benefit of that particular model. In relation to out of hours, I think it is really important to reflect on that, particularly in rural Ireland, particularly where it can be more difficult to get to somebody that you need. I was reflecting on Cork in particular, just in anticipation of your question, Deputy, and in relation to Canturk and Mallow, for example. There were issues going back in relation to 2023-2024 that you will be aware of better than I in relation to Canturk and McCroom treatment services. And the HSE did engage with South Doc on the matter, which confirmed that the centres were to be available by appointment only. I do think that it has been improved somewhat. I now am aware that there is a non-duty doctor physically present in the Mallow treatment centre each weekday night, which is important. You can see routine patients provide telephone clinical advice and also travel to locations such as Canturk to provide home visits. That is the support that is necessary, in addition to a second doctor in situ at weekends and public hospitals. We do need that out of hours facility, as Deputy Daly has highlighted, and we need to continue to make sure that that is part of the GP offering. Thank you. Okay, Minister. Senator. On reunite? Speaker 1 Speaker 2 Speaker 4 Speaker 1 Speaker 2 Speaker 1 Speaker 1 Speaker 1 Speaker 10 Speaker 1