Victor Boyhan: GP Shortages Put Rural Patients at Risk

Thank you Cathaoirleach for selecting this important commencement matter, thank you Minister for attending today, while I know you're not the Minister for Health but I know you have a health portfolio in brief. I want to thank you for giving of your time and coming, I know this is an exceptionally busy day in the Éireachtas. So my commencement matter deals with the GP shortages that are escalating with rural community belt communities being hit the hardest. I took a look at the parliamentary questions put to the House in the last 12 months, I saw the responses, there was the continuous response about a review mechanism, a review group, which no doubt you're going to tell me about in a few moments. I want to hear a bit more, I want to hear when this review is completing its work because if you look at the various TDs who continue to ask PQs, they're getting the same response. So now the time surely must be up but I'll deal with that in a minute. So the latest study of the Irish College of General Practitioners, the ICGP analysed the distribution of GPs practices across the country. But what I particularly appealed to me, and you know Minister I like figures and I particularly like figures around local electoral areas where our city and county councillors represent. So they use the model of the local LEAs for the city and county councillors to mirror this research and you'd be familiar with it or should be and I'm certainly happy to share a copy with you afterwards. And against this demographic and this mapping they came up with an exercise and it told us and confirmed for once and for all and this has already been confirmed by them. Indeed it's been recently reported by RTE on their newsfeeds. So the new data for the ICGP shows the areas of pressure where GPs are needed most is the North West. Donegal, North Mayo and Leitrim at the top of the scale. The north east border of Cavan, Monaghan and North Loud and my colleague and senator who represents that area I'm sure has great interest and knowledge of what's going on there. The mid-east commuter belt especially parts of Kildare and Portnt and Meath. The North Dublin area of Finglas and Coolock. The southeast LEAs of Kilkenny and Carlow and Wexford. The midwest of East Clare and East Limerick which you Minister would be very familiar with. So commuter belt areas are clearly under enormous strain and pressure. They have population growth, they have new development. This is outpacing the amount of new GPs coming on stream. We have in this country as of today 4,600 GPs in practice but the data by this organization estimates the need to be 6,000 GPs required to give coverage at this point in time. So this shortfall stems from delays in developing primary care centers. It also has impact on general practices etc. Particularly in rural areas where GP succession is a major challenge. It's a challenge not always a problem but it is a challenge and of course people's relationships would be GPs. We tend to stay with our GPs all our life and we're always someone telling me if you ever go and look for a GP make sure he's younger than yourself and he or she is younger than yourself and at least they'll see it through to old age. So older patients relying on the GPs are also suffering and being left out. So there is a challenge in terms of community care and I just want to push on a few issues to demonstrate to you my understanding of the problem having talked to GPs around the country over Easter to ascertain the difficulties and what they're telling me are simply the challenges are retiring and aging workforce, the rising demand, recruitment and retention, the rural imbalance of urban and rural, the workload pressures both on people but also on people within the profession, the impact this is having on patients and on some patients arriving in surgery and can't get cover, the difficult registration, rural discrepancies and disparities in different parts of the country and of course really what I want to hear about is what's the government going to propose. I am driven by solutions so I want to hear from you today about the solutions and finally I wrap up Minister just to say I think it's important that we have a look at the strategic review that the Minister initiated I think over a year ago I think it must be well advanced and how that's going to progress. Thanks very much. I would like to thank Senator Boyan for raising this important issue and I'm taking this matter on behalf of Minister for Health Jennifer Carol McNeill TD. The government recognizes the need for more GPs not only to meet current demand but to meet the future needs of our growing and aging population. A strong and sustainable general practice is essential to our health service and as Senator Boyan said GPs are a vital element, a component of our health system, do great work. For that reason the programme for government commits to increasing the number of practicing GPs through a combination of increased training places and international recruitment while several steps have already been taken in recent years to increase GP capacity. To make general practice now more attractive as a career and to increase the level of services provided to patients investment in general practice is increased by over 340 million under 2019 and 2020 GP GMS agreements. 2019 GP agreement provided for an almost 50% increase in capitation payments rates for GPs and a 10% increase to rural practice supports improvements to GP maternity and paternity leave arrangements were also made and a support for practice in urban areas deprivation was introduced. The 2023 GP agreement introduced a new grant for additional practice staff capacity and support for staff maternity leave taking. It also provides an open source support for rural GMS practices. You've already alluded to the rural practices. The annual intake of doctors into the GP training programme has been increased by approximately 80% from 2019-24 with 250 new entrances training places made available in 2024 and again in 2025. The number of new entrances training places is increased by a further 50 which brings it to 400 places this year 2026. As a result the number of GPs graduating is increased and will increase more in the next few years. Future increases in the number of GP training places will be kept under consideration. In addition, the recruitment of GPs from abroad commenced on the international medical graduate IMG rural GP programme in 2023. On this programme GPs work in general practice while undergoing two years of self-directed learning after which they can register under the Medical Council specialist register and take up a GMS contract themselves. As of 2019 there were 111 doctors in practice under the IMG programme, 58 more having completed a two-year programme. The placement of IMG GPs in practice is targeted in rural areas and difficult to fill posts in various locations around the country. In addition, the ongoing work to increase GP numbers and a strategic review of general practice is currently underway and I anticipated that you would inquire in terms of when it would be and the department advised me that it would be completed this year. The review was led by the Department of Health with support from the HSE and input from stakeholders to examine a range of important issues affecting general practice around capacity, training out of our services, e-health and the need for further and revised supports for general practice. The potential for HSE employed GPs as well as other possible measures to bring more GPs to underserved areas is also being examined. Finally, continuing to train, increase GP numbers and recruit more GPs from abroad will see our GP workforce grow while the work of strategic review will provide the basis for future sustainability of general practice. Before I call on the Senator, could I welcome guests of the Count Corle of Rona Murphy to the gallery from Pearstown National School. The most welcome to Shannon Aron and I'm sure the Count Corle told you that when you visit Shannon Aron, part of the experience is you have no homework for the rest of the week so make sure now that if there's anyone giving you any homework you write to me and I'll sort it out. Senator Victor Boyan. Thank you First I want to thank the Minister for his detailed response and hopefully the review will identify arrangements necessary to improve the current system of GPs. It's going on a long time so clearly our deputies will continue to ask PQs, we'll continue to ask commencement matters but I want to thank you and I want to thank the Minister for commitment to the review. I finished with two lines really. Firstly to thank the Irish College of General Practitioners for following the local authority electoral areas to do their research and give such quality of response and research and that has helped me today to do my work here which to advocate for these communities and I'd also like to word a caution that the GP shortages are putting rural patients at risk and that's an important call and I'm saying that here and now in the record of this house. GPs are telling me elderly people in our community are saying they feel they're at risk and many people are telling me they cannot get a GP and they're arriving indoors in Limerick and Cork and Monaghan and Donegal and Dublin and they've been told sorry you can go on a list but I'm not really interested or are you a private patient I might fit you in but I have no more room for public patients. We have a two-tier health system. GPs are not being given the support they need and I look forward to hopefully the strong recommendations that will come out of the Minister's review which is mandate to report to the Minister. The Minister will consider it and at some stage in the future has given the commitment to publish. So I want to thank you Minister. And can I join with the Caerlegan in welcoming Pierstown National School here. It's great to see so many young budding politicians seeing the channel in operation. So I would like to thank Senator Boyan again for raising this important matter. I'm taking the matter on behalf of the Minister of Health, Jennifer Carol MacNeill. The Government acknowledged there are existing precedents in general practice. The recent DSRI report on GP capacity shows that our aging and growing population which Senator Boyan has referenced along with the shift to provide greater care in community-based settings will increase demand for general practice services in the coming years in all areas with more GPs and general practice nurses required to meet this additional demand. The report identifies a need for between 943 and 1,211 additional GPs, between 761 and 868 GP nurses by 2040. The number of new GP training places is to increase to 400 this year as I said already. We have nearly doubled the number of new entrance places available since 2020. In addition, trained GPs continue to be recruited from abroad under international medical graduate and placed in practice in rural areas and underserved areas providing an immediate increase in service provision for those these areas where more GPs are most needed. Finally when completed the report from the Strategic Review of General Practice sets out a measure to provide for a more sustainable GP service into the future and the point specifically Senator Boyan you've raised obviously brought to the attention of the Minister for Health and the Department.