2026-05-19

Is the Minister of State taking the first Topical Issue?

I am taking all four.

Okay. I call Deputy Pádraig O'Sullivan.

I thank the Minister of State for coming in and taking the Topical Issue. As I mentioned to him a while ago, I might start by reading a letter I received from a constituent, who is a patient of one of the GPs affected by the issue I am highlighting this evening. He is a deeply respected GP: who has dedicated over four decades of his life to serving the people of ... [his] community ... [and he is now being] compelled, against his own wishes, to cease accepting Medical Card holders. The reason is not a lack of compassion, nor a change in his values - it is solely due to age-based restrictions imposed by indemnity insurance providers, which effectively penalise experienced doctors for the very attribute that makes them invaluable: their years of service. He is a physician of extraordinary dedication and record: At 72 years of age, this doctor brings with him a wealth of knowledge, clinical expertise, and human understanding that cannot be taught in a lecture hall or replicated overnight. He has served not just individuals, but entire families across multiple generations - delivering care with consistency, compassion, and a personal touch that has become increasingly rare in an overstretched modern health system. [...] His record speaks for itself - decades of service marked by trust, clinical excellence, and an unbroken commitment to those most vulnerable in our society. He knows his patients by name, by history, by circumstance. That depth of continuity of care is not merely a comfort; it is medically significant, reducing misdiagnoses, unnecessary referrals, and costly emergency interventions. What we are saying here tonight is that the system is essentially punishing this man's patients: Medical Card holders are, by definition, among the most economically vulnerable members of our society. They depend on access to free GP care as a lifeline. When a trusted, long-established doctor is forced out of their reach by an insurance policy that discriminates on the basis of age - not competence, not patient complaints, not clinical record - the consequences fall hardest on those least able to absorb them. Many of these patients are elderly themselves, or suffer from chronic conditions that require ongoing, familiar care. Being told to find a new doctor - often in a climate where GP lists are closed and waiting times are lengthy - is not a minor inconvenience. For some, it represents a genuine health risk. [...] The loss of Medical Card access through this doctor does not simply affect individual patients - it damages the social fabric of ... [the community involved]. A trusted local GP is more than a medical professional; he is a cornerstone of community health and wellbeing. His absence from the Medical Card system will place increased pressure on already overburdened emergency departments, out-of-hours services, and neighbouring practices, many of which are themselves at capacity. What the constituent is asking for here tonight is engagement "with the HSE, the Irish Medical Council, and indemnity insurance providers to explore immediate interim solutions that would allow this doctor to continue accepting medical card patients without undue personal or professional risk". We are also asking that a further review would be commissioned "of how current insurance and regulatory frameworks may be inadvertently excluding experienced GPs from public health participation". We are also asking to publicly "acknowledge the invaluable contribution of long-serving GPs and commit to policy that supports, rather than sidelines, their continued service to communities that rely on them". That is the correspondence I received from a constituent. It is happening in an area where we are already overstretched with GP services. There are two main things I would to point out. First, we are not confident that we can actually source alternative GP cover for those patients affected. Second, this man is still at the top of his game albeit he might be 72 years of age. As is outlined in the letter I received, he is well got in the community, well renowned, and I think his service would be lost to those medical card patients if this service were to be withdrawn from them.

I thank the Deputy. The letter from the constituent clearly describes a man who is absolutely dedicated to his profession, well respected in his community and has for decades provided healthcare for the people of that community. The Deputy has explained well how restrictions, especially in terms of indemnity being provided from private insurers but also the HSE policy he referenced, can impact his wanting to provide further healthcare for the community. I have been asked by the Minister, Deputy Carroll MacNeill, to outline the current policy and I hope we can have a further discussion after that. GPs are private practitioners, most of whom hold contracts with the HSE for the provision of public health services. Currently, 3,243 GPs hold at least one contract with the HSE, including 2,608 GPs who hold a General Medical Services, GMS, contract for the provision of GP services without charge to medical card and GP visit card holders. As private practitioners, GPs themselves are responsible for obtaining professional indemnity insurance from private medical insurance providers. Although the HSE contributes to GMS GPs' medical indemnity costs, neither the Department of Health nor the HSE has a role in the provision of medical indemnity to GPs. In that aspect, there is very little we can do in terms of intervention. Under the GMS scheme, GPs may hold their GMS contract until 72 years of age. This was recently extended from the age of 70 in 2015. That speaks to the point the Deputy makes about the case of the GP he has outlined, who is 72. The HSE can grant an extension on a case-by-case basis, where considered necessary and appropriate, to allow a GP to continue to see their GMS patients after reaching 72 years. After the age of 72, GPs can continue to provide services other than to medical card and GP visit card holders under the GMS. The HSE is actively involved in recruiting a replacement GP where a GMS vacancy arises. The HSE advertises GMS positions in advance of known upcoming vacancies, and every effort is then made to fill the GMS vacancy. Locum GP cover is provided in the interim for most cases, while in a small number of cases, the retiring GP is requested to remain in practice temporarily until the vacancy is filled or an alternative option is finalised. As of the beginning of April, there are only 20 GMS vacancies, with no GMS vacancies in County Cork. This equates to less than 1% of the total number of GMS panels. The Government is committed to increasing the number of GPs working across the country, and several measures have been undertaken in recent years to increase GP capacity and improve access to services for all patients. Investment in general practice has been increased by over €340 million under the 2019 and 2023 GP GMS agreements. The agreements provide for increased fees for participating GPs, improved and additional supports for practices, and new services for patients such as the GP chronic disease management programme. There is further text in the response but, just to summarise in terms of the Deputy's specific ask, the indemnity that a GP gets is very much between them and the indemnity provider. In the GMS contract, that age limit of 72 is clearly an issue. Certainly it is something on which I am willing to go back to the Minister for Health, give the Deputy's feedback and relay his concerns. That is the current state of affairs.

Like all good answers, maybe the door is slightly ajar there in the reply, "The HSE can grant an extension on a case-by-case basis, where considered necessary and appropriate, to allow a GP to continue to see their GMS patients after reaching 72 years." That begs the question as to what is deemed necessary and appropriate. I do not expect the Minister of State to have an answer to that given he is not in the Department of Health. Perhaps somebody could provide clarity on what is considered necessary and appropriate. Is it a cognitive assessment or some kind of medical assessment? I am not sure. Maybe clarity could be sought from the Department afterwards. I get why we have a cut-off in age. The various studies I have looked at in relation to this show that, cognitively, in terms of practice and so on, once people reach the age of 65, there is a reduced adaptability. Tests have proven and evidence suggests that older doctors may be less likely to adapt to new clinical standards, and I get that. Definitely in the case of this doctor at 72, it is not a case of not being able to teach an old dog new tricks. This guy is well renowned, quite able and ready to adapt. What he is asking for is fair play. Referring back to the Minister of State's answer, if it does require some kind of assessment to get him back into that bracket of his case being considered necessary and appropriate, I would like to tease that out. I do not expect the Minister of State to have the answer here, but that clarity would be sought, especially in a climate where we are extending the number of patients eligible for medical cards with every budget. The system is already under considerable pressure. If it is truly a case-by-case assessment that is allowable, I would ask that it be teased out to its fullest.

I picked out the same sentence the Deputy highlighted there, that the HSE can grant an extension on a case-by-case basis where considered necessary and appropriate. I guess the first part is where it is considered necessary. Does that come back to demand and vacancy in an area or lack of or challenges with GP cover? Certainly if it comes down to cognitive ability, of course surely that can be done on a case-by-case basis. It would seem like a simple thing to undertake. There is a saying down in west Cork that 80 is the new 60. Certainly we are living older and there are many 73-, 74- and 75-year-olds who are sharp as a razor, much sharper than I am in that regard. I guess that is the chink of light the Deputy is seeing in the answer there. Maybe this is a case where we can tease that out further. Is this a situation where the HSE might allow the GMS contract to go past the age of 72? Going back to the issue of indemnity, that is very much between the GP and the provider. Fair play to the Deputy for raising this, and to the constituent who so eloquently outlined why this particular GP should still have a GMS contract.