Dáil Éireann Debate, Tuesday - 15 February 2022
60. Deputy David Cullinane asked the Minister for Health his plans to address the crisis in general practice and general practitioner out-of-hours services; and if he will make a statement on the matter. [7840/22]
View answerI spoke earlier about the crisis we have in GP capacity. There are so many crises in health and I think the Minister will accept we have a real problem in this State. I am getting calls from people who are telling me that for the first time, they are having real difficulties getting an appointment to see a GP. It is not just Covid-related. It is a problem in rural areas but also in parts of Dublin as well. Many people cannot get registered with a GP. The HSE has said there is a deficit of up to 1,600 GPs. That is even before the 500 GPs it is anticipated will retire over the next five years is taken into consideration. That means 2,100 GPs will be needed over the next five years. What is the plan to make that happen?
I thank the Deputy very much for the question. It is a hugely important issue. I pay tribute to GPs and everyone working with them in general practice for the extraordinary work they have done through the pandemic and of late in stepping up around the Christmas period for the booster vaccines. They have been absolutely incredible.
There are capacity challenges facing general practice. There are access challenges for patients. As the Deputy rightly said, it can be quite variable in different parts of the country. One of the areas I am particularly concerned about is that the waits are especially bad in some lower-income areas. That is something that must be looked at as well. Steps we have taken recently in co-operation with general practice include the chronic disease management programme, which is going very well, and GP direct access, which is going very well and is helping with a lot of access. They are having a transformative impact in the delivery of quality care in the community that general practice is able to provide. However, as the Deputy quite rightly said, much more must be done.
The 2019 agreement with GPs was an important step in restoring general practice as an attractive option for medical graduates. What impact has there been so far? The number in training has increased quite a lot. In 2009, there were 120 coming out of training; last year, there were 233. We have further to go but it is a significant increase. The transfer of responsibility for training to the Irish College of General Practitioners, ICGP, was completed last year. That is a really important step.
We are also committed, under the 2019 agreement, to undertake a strategic review of general practice. This should have started before now but it was delayed by Covid. Work on the review is going to commence this year. The review will examine a wide range of issues affecting general practice and set out the measures necessary to deliver a sustainable service in the coming years.
The Minister's response sets out the scale of the challenge because we are talking about 233 training places. I engaged with the ICGP on this and approximately 30 places over the past two years were not available to allow some of those training places to be taken up. That is one of the problems. We need 2,100 GPs over the next five years to simply stand still. That is on a no-change basis.
We are all committed to universal GP access, but we are only training 233 people. Not all of them will go into the public system, not all of them will sign up to the GMS contract and not all of them will become GPs. Some will go into hospitals and stay there and some will leave. We have a real crisis and unless we ratchet up the number of training places and have a much more joined-up approach between the training body, the acute hospitals to make sure people are trained, and the actual need, we are in real difficulty.
Yes, I agree. We have to continue with the graduate training posts but we have to go much further than that. I talked to a rural GP from the Deputy's neck of the woods in Waterford a while ago, and she estimated that her maternity leave, which she totally funded herself, will cost her approximately €60,000. This is a brilliant young GP in Waterford. She was considering splitting a GMS list as she wanted to change the balance and pull back, but the rules are not in place to allow her to do that. As a result, she was thinking about moving to Australia. That is just completely unacceptable.
Yes, we need to increase the number of training places, but what I want from the review this year is for us to listen carefully to GPs, at various stages of their lives, to hear what they need to make this a job that would attract them, they would stay in and where they would continue to develop and work with others in a multidisciplinary way.
The example the Minister gave of a GP in Waterford is very important, and he has listened to what she had to say, but he is the Minister and he can effect change. If I was in his shoes, I would establish a working group on the future of general practice and I would look at a new model of GP and primary care, including the option of directly hired GPs, if that is what we need to do.
We need a new GMS contract. The Minister is right that many GPs who are coming out of training all of a sudden find they are entrepreneurs and businesspeople and they need practical supports regarding that. There are issues relating to staffing subsidies, which are based on an archaic view of how practices work, when we know general practice has completely changed. The GMS contract needs to reflect a modern, primary care service. All the other supports the Minister mentioned also have to be put in place. It is all of that.
If we are to have any chance of expanding free GP care, and delivering on the promise that was made, all of this needs to be done. If it is not, a legacy of the Minister and the Government will be that of another party that promised to deliver reforms in healthcare to transition to a single-tier health service and universal GP access, but failed. They will only fail if they do not grapple with these issues. While the Minister is listening to GPs, I do not see any evidence of any concrete changes so far.
As the Deputy quite rightly said, the ambition is very serious. The ambition is ultimately for free GP access to be the norm in our country, not just for children. That is where we have to go and we have to get there quickly. To do that, there has to be massive investment in general practice, including in the numbers, as we have discussed, and in the supports around them, such as eHealth, where there are some good initiatives but which is not rolling out quickly enough. The GMS contract will have to change. It will not work for the level of ambition of what we have in mind and, as we know, it does not work in some parts of the country anyway. In many parts of the country, some people are struggling to get onto a GMS list and that is not acceptable.
The Deputy said he would set up a working group this year. We are doing that. It was promised under the 2019 agreement. For reasons we can all accept, it was not possible over 2020 and 2021, but we are doing that this year. It is important to me that the starting point will be to listen to GPs very carefully and hear what they need to develop general practice.
