Tuesday, 26 November 2019

Ceisteanna (41)

Michael Harty


41. Deputy Michael Harty asked the Minister for Health his plans to address the failure to fill the vacant general practitioner posts in Newmarket-on-Fergus, County Clare, Milltown, County Kerry, Macroom, County Cork, and in many other locations nationwide; and if he will make a statement on the matter. [48817/19]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)

What are the Minister's plans to address the failure to fill vacant general practitioner posts in Newmarket-on-Fergus in County Clare, Milltown, County Kerry and Macroom, County Cork, and in many other locations around the country?

I thank Deputy Harty. As of 1 November, there are 22 vacant general medical services, GMS, general practitioner posts nationwide. These vacancies account for less than 1% of all GMS panels. The HSE is actively recruiting to fill the vacancies referred to by the Deputy in Newmarket-on-Fergus and Macroom, and is considering available options with the local community in Milltown. I believe there is ongoing active engagement in that regard. In the case of each vacancy, a locum or other appropriate arrangement has been put in place to maintain GP services in the communities in question.

The Government is aware of the workforce issues facing general practice, including the difficulties in filling certain GMS vacancies. I assure the Deputy that the Government is committed to the continued development of GP capacity, so that patients across the country have access to GP services, and that we have taken a number of measures to improve GP recruitment.

The recent agreement on GP contractual reforms, which was endorsed by 95% of GPs who participated in the consultative Irish Medical Organisation, IMO, ballot, will see an increase in expenditure on GP services of €210 million annually by 2023, providing for significant increases in capitation fees, the effective full reversal of financial emergency measures in the public interest, FEMPI, plus additional supports for rural practices and, for the first time, practices in urban areas of deprivation.

In addition, I am very encouraged to see that the number of medical graduates undertaking GP training has increased from 120 in 2009 to 192 filled places in 2019, with a further increase expected next year. In a recent press release, not from me but from the Irish College of General Practitioners, it stated the good news that it had received the highest ever number of applications for its 2020 GP training programme. Our job is to make sure that we keep those GPs working in communities in all parts of the country. I believe the changes to the contract are attractive in that regard. I am confident that these measures help make general practice more sustainable and a more attractive career option for doctors. I am aware there is ongoing work in each of the three locations referenced by the Deputy. The HSE is very engaged in trying to find a full and sustainable solution in each of these regards and it has provided locum cover in the interim.

I believe there was a lost opportunity for the sustainability of general practice in respect of the deal that was brokered between the Minister, the HSE and GPs earlier this year. As the Minister has often said, 95% of GPs have signed up to that deal. Of course they would because it is returning financial emergency measures in the public interest, FEMPI, money that was taken from them over the years. However, it has not addressed the issue of GP recruitment. The contract underpinning GP recruitment is out of date. It was introduced in 1972 and has undergone so few changes since then that it is not fit for purpose. It does not recognise the changing and expanded role of general practice. It does not attract new entrants into jobs such as in Newmarket-on-Fergus. That was a perfectly run practice yet it could not attract a GP because of the contractual commitment that a GP has to engage in is so onerous when running a small business. GPs want to work. They are inflicted with a responsibility they do not want to take on as a result of the contractual arrangements they are offered. The fundamental issue in respect of recruitment is the fact that we do not have an up-to-date, modern contract.

I assure the Deputy that I do not consider our engagement with the GP bodies to be done. I very much consider the measures we have taken in recent months to be about initial sustainability after a number of difficult years for GPs. They did not just all sign up; they went out and voted in a ballot that they thought this was a good deal. We are providing significantly more funding and not just returning what was owed to them, as is sometimes said. We are going well above and beyond that and providing for the first time additional supports in respect of paternity and maternity leave, a fund for areas of urban deprivation where we sometimes have difficulty attracting GPs, and increased rural allowances. I accept there is more to be done.

Regarding the three areas the Deputy mentioned, in Newmarket-on-Fergus in County Clare the GP post has been re-advertised with a closing date of 12 December. It is planned to hold interviews for this post early in the new year. In Milltown, County Kerry, in light of the community reaction to the announcement, Cork Kerry Community Healthcare rightly had a meeting with local community and public representatives to listen to concerns. It has postponed the closure of the practice to provide time to the local community to work on additional measures. Finally, in respect of Macroom, this post is currently being advertised again both in Ireland and internationally. A locum GP is in place as of 16 September and is providing services for both general medical services, GMS, and private patients. All other practice staff such as the nurses and secretary remain in place and remain funded by the HSE. The locum doctor will continue to be funded until the post is filled.

I am sure all the Minister's Fine Gael colleagues have similar stories to the ones I outlined in my question. This is a national issue, which is not just confined to the three practices I mentioned. When a list is unfilled, as these and many others are, there is great anxiety within the community. When a GP position is unfilled, there is a loss of community cohesion and an unravelling of the fabric of a rural society. There is a loss of pharmacy services. It is impossible to sustain a pharmacy in a town or village if there is no doctor. No village or town in Ireland has a pharmacy without a GP. There is a loss of support to the ancillary services within the community. There is a loss of community intervention team support, public health nursing support and home help support. When these lists are left unfilled for a substantial period, by the time somebody is appointed, very few remain on the list. When a community loses a GP, there is decreased access to primary care services and to the supports patients get within the community. House calls to the frail and elderly and palliative care work are removed from that area and transferred to the nearest town, where it is not sustainable to deliver that service. There is a lack of sustainability also in out-of-hours services. As GPs are lost, the out-of-hours service struggles to continue. The result is increased attendances at emergency departments because patients cannot get primary care services when a GP is not there. Once the list is gone, it is gone forever. The Minister talks about 22 vacancies. At least 200 practices have closed over the past ten years, which are not counted. They no longer exist. GP services will not return to those towns or villages.

I do not disagree with some of the comments the Deputy has made. However, I need to be clear that as Minister I have brokered an agreement with GP representative bodies and will restore every cent that was removed in capitation fees during the recessionary years by 2023. The agreement will provide more than that as well. It is providing additional funding that GPs sought for rural areas; funding for urban areas of deprivation for the first time ever; and paternity and maternity cover. We have been responding to many of the issues, although we have more to do as we have heard directly from GPs. I have also listened to GPs regarding eligibility issues. They have asked me to make sure I sequence this correctly and invest in general practice before I swamp them in respect of eligibility. Those are their words as opposed to mine. I have listened to them on the phasing in of the introduction of free GP care for children, and not going in one swoop to cover under 12s but introducing it in two-year intervals. We are seeing in recent weeks more people applying to train to be a GP than ever before in the history of our State. That news has been welcomed by the Irish College of General Practitioners. I accept that we have a lot more to do and that in particular parts of the country we have challenges. The HSE is engaging on the ground in that regard. We are training more GPs than ever. We need to make sure they want to remain GPs in Ireland. That is why it is important that we do not just pat ourselves on the back and say we have negotiated a good deal. We must look at how we continue to build on the relationship.