Wednesday, 13 March 2019

Questions (36)

Dara Calleary


36. Deputy Dara Calleary asked the Minister for Health the measures he will take to secure the viability of rural general practitioner services; and if he will make a statement on the matter. [12204/19]

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Oral answers (7 contributions) (Question to Health)

I understand that the Minister of State, Deputy Finian McGrath, is back in his spiritual home of Cuba as we speak. I have spoken to him previously about rural GP services. The Minister of State, Deputy Jim Daly, knows from his local area that the offer has to be changed to make it far more attractive for GPs to come to work in rural areas. We also have to support our existing GPs. Since I raised this issue a few weeks ago, I have been inundated with calls from all over the country from existing GPs who are about to throw in the towel because of the pressure they are under, the lack of backup and the lack of understanding. I ask the Minister of State not to give me the standard answer about the GMS contract because that is not good enough anymore. We need a whole new response and a whole new focus. Perhaps the Minister for Rural and Community Development needs to be involved in this as well.

I thank the Deputy for the question. I know he does not want the standard answer which mentions that the contract is very central to the future of GP practice. Whether we like it or not, the existing contract has been in place since 1971 or 1972. The renegotiation of that contract is a central aspect of the development of GP practice into the future. In recent years, we have invested in and significantly increased the GP allowance for rural practices. However, such practices continue to face many pressures. I take the Deputy's point that all these issues will not be solved by contract renewal alone. Much of this relates to the implementation of Sláintecare, a reduction in our reliance on GPs and better management of GP practices. Into the future, initiatives like nurse-led practice and nurses seeing more people will be features of GP practices as we seek to make sure such practices are sustainable. There has been a significant increase in the number of training places for GPs. I think the number has increased to 193 this year. There has been a big percentage increase. I do not have the exact figure to hand. That will help with availability. Many GPs find it difficult to get replacements when they are under pressure and cannot manage, when they need time off and when they are putting together rotas and rosters.

It is absolutely crucial that the discussions are finalised immediately. The Minister of State met 500 GPs outside the gates of Leinster House recently. They are fed up and are about to walk away. While the increase in training places mentioned by the Minister of State is welcome, the irony is that the places being provided are not being taken up. I would love to see the figures. In recent years, there have been vacancies in the west of Ireland training scheme for the first time. A career that used to be seen as a great one is no longer seen in that light. The Government needs to address the core issue of why general practice is not seen as an attractive profession. The Minister of State has spoken about the increased GP allowance, but it has not kept up with costs like insurance and equipment. It has not kept up with the demand on patients. It has not kept up with rural depopulation, which is affecting the ability of GPs to make a sufficient income from their existing lists. The allowance has to be changed. The Government needs to go back to the way things used to be done. It needs to provide surgeries and facilities on an ongoing basis so that people can locate in these areas. The financial model needs to be completely changed. Most of all, the Minister cannot allow the current situation, in which there are no respondents to GP vacancies when they are advertised, to continue. Surely that in itself is a wake-up call for the Government. It shows that there are problems with GP services. The Government needs to act to provide a better on-call service. Rural GPs need better backup for on-call. A range of issues are being put on the long finger while the flight from the profession continues.

The on-call issue is a significant one for rural GPs. I think it is one of the biggest causes of stress. GPs in more built-up areas do not face the same demand with regard to on-call as GPs in rural areas. The number I have given in respect of training places might not be correct. I will get the correct figure for the Deputy. I have given a number from my head, but I cannot rely on my head. I will come back to the Deputy with the exact figure. There has been a significant increase in the number of training places. I take the Deputy's point that they are not being filled. We have to make sure they are being filled to continue the flow of people. We are aware of the stresses being faced by rural GPs. As the Deputy has acknowledged, I represent a rural area. I know many GPs who have brought these issues to my attention. I am sure our colleagues, Deputies Margaret Murphy O'Mahony and Michael Collins, are well aware of the issues in rural areas as well. There is a significant investment attached to the renegotiation of the rural GP contract. I think that will go a long way towards addressing some of the issues that are significant for GPs. As I have said, work practices have to be looked at. We will do this. We will continue to engage with the representative bodies on the wider range of issues affecting GPs, particularly in rural areas.

I appreciate the Minister of State is aware of this issue, but I ask him to do something about it. The contract talks have been going on for longer than the Brexit talks. It seems to be easier to resolve Brexit than to resolve the GP contract. I have mentioned the specific case of Bangor in my constituency. When the position there was advertised previously, there was just one applicant. A local solution has been put forward. We are engaging with the HSE, which will have to engage with the local solution. I ask the Minister of State, who is responsible for primary care, to give his attention to the Bangor situation. All the political representatives from the constituency are working collectively on it. We cannot allow the people of Bangor to be left without a GP again. People must not be allowed to stick their heads in the sand when a local solution is on offer. This is an urgent matter. We are losing very good and qualified people to Canada, Australia and the United States because of something small. There are small things that can be done to fix this problem, to make general practice an attractive career again and to provide and essential rural service. We cannot put the contract negotiations on the long finger. They have been delayed for long enough.

There is nobody who would like to see the contract negotiations brought to a conclusion more than me, the Minister, Deputy Harris, everyone in the Department of Health and the other Ministers on this side of the House. As the Deputy will appreciate, there are two sides involved in the negotiations. It is not just within the Government's remit to end the negotiations. Both sides have to reach satisfaction. The Irish Medical Organisation, which is the representative body of the doctors, must also get agreement from its members up the line. We are very anxious to see this process brought to a conclusion. We are prepared to provide the additional significant resources that are required to bring that about. Many issues are still being teased out by both sides. It takes two to tango, but it takes two to agree as well. Those of us on this side of the House, like the Deputies opposite, really want to see agreement. I do not think there is any political disagreement on this issue. There is no difference between the positions of Deputies across the House on issues like GP contracts and the sustainability of GP services. The primary care sector is an area of medicine that works very well. GP practices are crucial for rural and urban areas. They are delivering superb services. We recognise their value and want to see it recognised. I will take an interest in Deputy Calleary's local area. I am quite happy to see whether anything can be done in the Bangor area, which he has mentioned.

We will move on to Question No. 39, in the name of Deputy Calleary.

Question No. 37 replied to with Written Answers.
Question No. 38 answered with Question No. 28.