2026-02-25

I move: That Dáil Éireann: recognises that: — access to timely General Practitioner (GP) care is a fundamental pillar of a safe, effective and equitable health service; — GPs play a vital role in our health service, managing the majority of people's medical care needs, and acting as the first point of medical contact for most patients; — GPs provide a core leadership role in delivering care outside of the hospital setting, and are central to the provision of Sláintecare's new model of integrated, multidisciplinary care; and — to continue the shift away from our current hospital-centric system, patients must have timely access to GP and community-based healthcare services that are free at the point of use; notes that: — Ireland is an outlier in Europe in not providing universal primary healthcare that is free at the point of need, instead, we have a system of eligibility which is determined primarily on the grounds of income or age; — according to the Health Service Executive (HSE) Primary Care Reimbursement Scheme, approximately 42 per cent of the population has access to free GP care through medical cards or GP visit cards, and the remaining 58 per cent pay out of their own pocket; — the cost of visiting a GP can range from €50 to €90; — in 2025, research commissioned by the Irish Cancer Society found that more than 30 per cent of people surveyed didn't attend a healthcare appointment because of cost; — the same survey revealed that 25 per cent of people prioritised other costs over their healthcare, including heating and eating; — a key recommendation from the Oireachtas Special Committee on the Future of Healthcare Sláintecare Report, published in 2017, was universal GP coverage by year five of implementation; — the 2016 Programme for Government committed to extending free GP care to under 18s, which never happened; — free GP care for children aged under six was rolled out in 2015, but it took another eight years before free GP care for children under eight was authorised in 2023; and — the 2025 Programme for Government commits to extending free GP care to children up to at least 12 years; further notes that: — the 2017 Sláintecare Report stated that the current GP contract was a barrier to a primary-care orientated health service, and recommended an entirely new contract to facilitate new ways of working; — the current GP contract is over 50 years old, and although it has been amended on numerous occasions, the core contract does not reflect modern day general practice, nor the future career expectations of young trainees and GPs; — research carried out by the Irish College of GPs in 2023, found that almost half of trainees, 48.1 per cent, were not prepared to take up the contract within a year of finishing their training; — the same research found that just above one third, 36.7 per cent, of graduates felt comfortable with the traditional responsibilities of the GP principal/partner position; — the need for better working conditions, greater flexibility and new ways of working has consistently been identified by the Irish College of GPs and the Royal College of Surgeons in Ireland, in their GP Retention Project; and — in April 2023, the Department of Health and the HSE initiated a Strategic Review of General Practice, which was due to be completed that year but is still ongoing, nearly three years later; acknowledges that: — according to the Economic and Social Research Institute, an additional 943 to 1,211 GPs will be needed by 2040; — while the Irish College of GPs estimates that 2,000 more GPs are needed due to current demand of our aging population and population growth; — in 2024, just two counties exceeded the World Health Organization's recommended ratio of 100 GPs per 100,000 of population, with areas of deprivation and rural areas worst served; — it is well established that there are higher and more complex health needs in areas of deprivation, yet there are fewer GPs working in these communities compared to more affluent areas; — it is estimated that Dublin's North Inner City has one GP for every 3,525 people, compared to the national average of one GP for 1,759 people; and — a third of the population lives in rural Ireland, yet the Irish College of GPs estimates that only 10 per cent of GPs work in these areas, with many in solo practices; further acknowledges that: — the Chronic Disease Management Programme (CDMP) has clearly demonstrated what general practice can deliver, when structural programmes, which align with Sláintecare, are implemented and resourced; and — last year, the HSE's report on GP-led Chronic Disease Management found that participants in the programme had 30 per cent fewer emergency department attendances, 26 per cent fewer hospital admissions, and 33 per cent fewer GP out-of-hours visits; is concerned that: — many GPs are overworked, burnt-out and increasingly overburdened with administrative work, all at the expense of their own work-life balance; — in the absence of reform, we are seeing the increasing corporatisation of general practice, with small family practices being bought up by investor-owned corporate entities with multiple locations; — a significant number of GPs are approaching retirement, with the Irish College of GPs estimating that 600 GPs are aged 65 or over, 300 of whom are aged 65 to 69, and 300 of whom are still working aged 70 and over; — according to an Irish Independent survey of 275 registered GPs carried out in 2024, more than half of the GPs could not accept new patients, with more than two out of three GPs in rural Ireland unable to take on new patients; and — there are critical gaps in out-of-hours GP services, and capacity constraints in daytime general practice are putting additional pressure on out-of-hours services; and calls on the Government to: — in the forthcoming budget, implement the Programme for Government commitment to expand free GP care to children up to 12 years of age; — immediately set out a clear timeline for the delivery of universal GP and primary care, which is free at the point of use, within the lifetime of this Government; — introduce a salaried GP model, with GPs directly employed by the HSE, for underserved communities, beginning with rural areas and offshore islands, and expanding into areas of deprivation and out-of-hours services; — create a new DEIS for GPs scheme, deprivation-weighted General Medical Services capitation rates, with a cap on list size, in recognition of the additional health needs of patients in deprived areas; — expand locum cover supports for GPs, by developing a nationwide HSE locum bank to ensure all GPs can take leave; — develop a new GP contract which facilitates new ways of working, meets the work-life balance and career expectations of younger GPs and trainees, and incentivises health promotion, public health work, disease prevention, and the delivery of integrated care; — invest in a national GP Clinical Lead role, to design, test and support new models of rural and remote general practice care; — establish a primary care health equity working group, with representation from frontline services and patients living in deprived areas, similar to the successful Scottish model; — accelerate the delivery of HSE-built primary care centres, to provide suitable premises for GPs and their teams, and support the delivery of integrated, multidisciplinary care; — develop a national strategy to attract, support and retain future GPs, and this should include increased exposure to general practice in medical schools, structured post-training fellowships, specific time spent in practices in both rural areas and areas of deprivation during GP training, and measures to support more diverse, flexible, and equitable career pathways; — accelerate implementation of the Irish College of GPs' 2023 report, entitled "Medical Student to General Practitioner - An urgent call to action"; — provide an additional 100 GP training places, through the expansion of training capacity in hospitals and supporting training practices; — implement a new model of out-of-hours GP care, which is uniform across the country, to ensure that access to out-of-hours care is consistent; — align general practice nurses' terms and conditions with their HSE colleagues, recognise and support general practice nurses' continuing professional development, and establish clear career pathways for progression; — increase annual public health nurse training capacity, from 160 to 240 places; — remove the Common Conditions Service fee for medical card holders; — provide universal access to the CDMP for all patients with type 2 diabetes, asthma, chronic obstructive pulmonary disease, cardiovascular disease and any further expansions such as the planned inclusion of chronic kidney disease; — expand the CDMP to include severe and enduring mental health difficulties, epilepsy and other conditions as appropriate, in consultation with GPs delivering the service; — develop a structured women's health programme for general practice, which deals with contraception, screening of STIs, fertility, pre-conception, endometriosis and menopause; and — develop a national GP data framework to provide for integration with future eHealth systems, standardised data collection, greater data flow, data stewardship and investment in analytical capacity. GP services are the bedrock of our health service but they are built on crumbling foundations. The warning signs of this looming crisis cannot be ignored any longer because timely access to GP care is a cornerstone of safe, effective and equitable healthcare. It is now almost nine years since Sláintecare was published. It was a ten-year plan to deliver universal healthcare based on need and not ability to pay. While Sláintecare is still Government policy, at least on paper, it now feels like delivering universal healthcare has been relegated to some time in the future and little more than a nice idea because if this Government was truly serious about delivering universal healthcare we would be well on the road to free GP care by now. However, the sad reality is 58% of the population are still paying up to €90 to see their GP, and that is just get in the door. Promises to remove costs have been broken time and again. The 2016 programme for Government committed to extending free GP care to all under-18s but a decade later all that has been delivered for children is an extra two years of free GP care; up from under-6s in 2015 to under-8s in 2023. The latest Government pledge is to deliver free GP care for under-12s. That programme for Government commitment needs to be implemented this year and a roadmap for delivering universal coverage by 2030 must be set out. GP care should be free. This might sound radical but it should not. Nowhere else in Europe would you be paying between €50 and €90 just to see the GP. It costs nothing to see the GP in most European countries, including Austria, Czechia, Denmark, Estonia, Germany, Greece, Hungary, Italy, Lithuania, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia and Spain. If you are in Croatia, Bulgaria, France or Latvia you pay just €1 or €2 to see your GP while in Belgium and Luxembourg it costs no more than €7. In Cyprus, it is at most €15 and even at the higher end in Finland and Sweden, it costs on average €30. Meanwhile in Ireland the majority of people are paying double if not triple that to see their GP. This is not normal yet there is no sign of a plan from Government to change that. Hiding behind the strategic review of general practice just will not cut it any longer. That review was first promised in 2019 yet it still has not been completed seven years later. The core GP contract is over 50 years old and even though it is has been amended many times, it is still not fit for purpose. For example, we are still expecting most GPs to provide their own buildings. We would not ask a teacher to build a classroom, so why ask a doctor to build a surgery? Why is it we still have not recruited HSE-employed GPs as recommended in the 2017 Sláintecare report? Surely it is a no-brainer, especially for underserved communities in rural areas and offshore islands. The ICGP research shows more and more younger GPs have no interest in the responsibilities that come with the traditional business model. They do not want to run a small business; they want to provide healthcare and this should not be too much to ask. A new contract and new ways of working alone will not address the looming crisis in general practice and that is why our plan published today contains 20 proposals, including further measures to increase capacity such as strategic workforce planning, more training places and a new locum support service. In areas of deprivation more specific reforms are needed. That is why we are proposing a DEIS for GPs scheme. This will provide deprivation-weighted GMS capitation rates. Currently there is a significant jump in capitation rates for patients over 70 and while age is one of the most important determinants of health, it is not the only one and deprivation must also be recognised because patients living in disadvantaged areas have higher health needs at a much younger age. It is also important to say general practice is more than about doctors. GP nurses are indispensable members of the practice teams yet their value is under-recognised. This is why we want to see an alignment of the HSE rates for nursing pay as well in general practice. We in the Social Democrats except general practice needs more than a quick fix. What is needed is an entirely new approach to protect the unique value of general practice because the relationship between a patient and the GP is unlike any other in healthcare. Government cannot simply ignore this looming crisis in general practice any longer. A plan is needed, not a never-ending review. This is why the Social Democrats are proposing a 20-point plan to reform general practice. I hope the Government accepts it and implements it in full.

I thank my colleague, Deputy Rice, for all of his hard work and passion on this issue. Our GP services are stretched beyond their limits. In most areas of my constituency of Cork South-West GP practices are no longer taking on new patients. People ring practice after practice only to be told there is no room. Families who move to the area cannot access primary care locally. Young people ageing out of paediatric care struggle to find a GP of their own. This is not unique to west Cork and is happening all across the country, particularly in rural areas. This is about basic access to healthcare - to fundamental vital care that should be available locally without charge. There is no justification and no excuse for people being priced out of a GP visit. It is the bare minimum the State should provide and it is the norm across western Europe. Infuriatingly, Ireland continues to cling to a two-tier model of health where access, speed and quality of care can depend on your income. Nine years ago, and lead by Róisín Shortall, we achieved cross-party agreement this could not continue. Sláintecare set out a ten-year plan for universal healthcare with free GP access for all by year five. It is nine years on and we are nowhere near delivering it. When cost remains a barrier people delay care. They wait a week then another and hope symptoms pass. Minor infections become more serious, manageable conditions escalate and inevitably pressure then shifts to already-overcrowded emergency departments. Extending GP care is not radical but logical. Our motion calls for free GP care for under-12s this year and for universal free GP care by 2030. It is a clear, achievable pathway to ending financial barriers once and for all. Expanding access must go hand in hand with expanding capacity. A significant number of rural GPs are approaching retirement. Many practices rely on one or two doctors covering huge geographical areas often without proper locum support. When one retires or even takes well-deserved leave, the impact on their community is immediate. One of the main barriers to attracting young doctors into rural practice is the cost and administrative burden of setting up a business, so we need a new approach. The Social Democrats are calling for a new GP contract and the introduction of salaried GPs directly employed by the HSE starting an underserved rural communities and offshore islands. This would remove the financial risk for doctors and give communities security. It would introduce a DEIS for GPs scheme with deprivation-weighted capitation rates so practices serving disadvantaged communities are properly funded for the higher level of need and a nationwide HSE locum bank, so GPs can take annual leave, parental leave and sick leave like any other worker while ensuring continuity of care for the community. To have a comprehensive out-of-hours service to access the care you need should not be a postcode lottery.

I begin by commending Deputy Rice on bringing forward this motion and basing it on in-depth engagement with people affected by the crisis in GP care as well as with policy that can address it. The Government is blue in the face accusing the Social Democrats of having no solutions to the problems we highlight, which are problems it has created through a failure to plan, a failure to invest and a myopic ideological default to privatisation. The Government can rest easy today because this motion contains clear and practical solutions, which, despite the Government's narrative, we consistently tend to provide. At its core, this debate is about something simple yet transformative. Access to a GP is the front door to our health system. When that door is locked or costs too much to open, so much else backs up behind it, leading to hospital waiting lists, overcrowded emergency departments and untreated illnesses in our communities. The evidence collected by Deputy Rice is overwhelming. Our party survey shows that while almost all respondents are registered with GPs, only one in eight can get a same- or next-day appointment. One in three face a wait of a week or more and nearly half of respondents ended up in emergency departments or out-of-hours services simply because they could not access daytime GP care. This is not a functioning general practice system; it is a system under severe strain. Cost is also a major barrier. Three in five people report delaying or avoiding seeing their GP because of fees, which can range from €50 to €100. Ireland, as Deputy Rice outlined, remains an outlier in Europe by not providing universal GP access free at the point of need. Sláintecare settled the principle of universal access years ago. What is missing now is delivery and a credible timeline from the Government. Capacity pressures are equally stark. The ESRI estimates that we will need up to 1,200 additional GPs by 2040. The Irish College of GPs, ICGP, suggests that the shortfall may already be closer to 2,000. At the same time, hundreds of GPs are approaching retirement. One of the structural problems in this regard is that we continue to expect doctors to become entrepreneurs if they are to become GPs. Young doctors finishing training are effectively being asked to set up and run small businesses. They must secure a premises, hire staff, manage payroll and deal with administration and financial risk before they can even begin providing medical care. For many, that model simply no longer fits modern medical careers or life. It is a major barrier to recruitment, particularly in rural areas, socio-economically deprived communities and fast-growing towns. Direct recruitment of doctors by the HSE through a salaried GP model would offer a practical way around this. It would allow GPs to focus on clinical work rather than business risk. It would remove the upfront financial barrier to establishing practices and give the State a direct means of replacing GPs when the need to do so is greatest. Access is also deeply unequal. Rural communities struggle to recruit doctors. Deprived communities carry heavier illness burdens and have fewer GPs.

I thank my colleague, Deputy Rice, for bringing this motion forward and the huge amount of work he has done in outlining what we should have in this country, that is, free GP care. As already stated, Ireland is an outlier when it comes to free GP care. In Europe, access to adequate GP care, especially in disadvantaged areas like parts of my constituency of Dublin South-Central, is vital in order to have healthy communities. Research from adverse childhood experiences and longitudinal studies like the Irish Longitudinal Study on Ageing show that ageing populations need greater care and disadvantaged areas need preventative care from an earlier age. Adverse childhood experiences are more prevalent in areas of socio-economic disadvantage because of intergenerational poverty and trauma. A child who experiences four or more adverse childhood experiences growing up is more likely to die prematurely of preventable diseases. For those who do not know, an adverse childhood experience includes a child growing up in poverty, living in homelessness or an insecure housing situation or being the victim of abuse, whether physical, sexual, psychological or emotional. When this is combined with life choices, such as addictive behaviours or psychological and mental health challenges, it leads to poor medical outcomes for people who have experienced such adversity. It is vital that GPs in poorer areas of the country, where adverse experiences are more prevalent, are trained to understand not only why it happens but how to help and deal with someone who comes to them in adult life for support. Of course, those GPs need to be supported because they are more likely to suffer burnout, similar to other people working in those communities. Of course, GP care is not available often because of pricing or the lack of timely appointments. Some of the responses from the survey that Deputy Rice gathered state, “Trying to get an appointment is like winning the lottery. They are always busy.”. Another individual stated: I actually rarely bother going to the GP as the typical wait time for a chest infection is six weeks. Because of this, I have to go to the out-of-hours doctor. If I were to wait for the GP appointment, I would be healthy again by that time. I should not have to just wait for a bad chest infection to pass and be in pain when I could get antibiotics and be ok within the week. If adverse childhood experiences cannot be prevented, we have to be able to deal with them. If people cannot get appointments because they are not available or too expensive, that will create a challenge for them.

We heard from Deputy Rice about the extortionate cost of GP care for families all across the country, which ranges between €50 and €100. Not only is that incredibly expensive, but woman will probably pay double that to get basic healthcare once they are premenopausal or menopausal. GPs will charge between €120 and €200 or, perhaps, €250 for a consultation when it comes to menopausal clinics. That is an incredible amount of money. We are in a lucky situation where we know a lot more about menopause. We know the symptoms. A total of 51% of the population will experience menopause. Some will sail through it, while others will find it more challenging. For those who find it challenging, there are medical interventions available. I welcome the hormone replacement therapy, HRT, initiative the Government came out with. That is important. For women wishing to go on HRT, however, they must first be assessed. In order to be assessed and receive a prescription, they have to go to their GP. If they go to their GP with any symptom that could be related to menopause, they will be charged extra. They will be charged €150 plus whatever else it costs for the blood work. That is just for one consultation relating to menopause. I do not know of any other medical condition for which people have to pay extra to be seen. I have spoken to GPs about this and the rationale is that they are longer consultations. That is fair enough. There is probably an argument for that. However, if I were to go to my GP with a mental health issue, it would require a long consultation but I would not be charged extra. If I were to go to the GP with more serious medical issues, they would also involve long consultations, but I would not be charged extra. I do not understand why menopausal women have to pay twice or three times the amount a normal GP clinic charges. That is inherently unfair. I acknowledge the free HRT. It has been a lifesaver for so many. When times are tough and family budgets are tight, however, I know women will not look after themselves. If that means not getting a GP appointment because it will cost €150 or €200, they will sacrifice their health so that their family can be looked after. That should not be the case. I ask the Minister of State to take that on board and look into those unfair costs for menopausal women.

I thank Deputy Rice for the dedication and vision he has brought to this most important issue. There is a postcode lottery when it comes to accessing effective doctor care within our system. To give context, the national benchmark is one GP per 1,759 people. In my constituency of Dublin Central, it is dramatically higher. In the north inner city, for example, it is one GP for every 3,525 people. In Cabra-Glasnevin, it is one GP for every 3,060 people. In my constituency, particularly in the north inner city part of it, there are a plethora of issues we often discuss, no different to many other constituencies. There is poverty, deprivation and inequality. When looking at the GP-to-person ratio, it cannot be denied that a structural inequity is also built in. I have visited the GP Care for All practice in Summerhill many times over the years. When people visit the practice, which was founded by Dr. Austin O’Carroll, they will find communities of people who have grown up and spent their whole life in the inner city. They will find the Roma community and people who have come from other parts of the world. There is a diverse community there, all with a particular need that is clearly under-served. In the north inner city, we have known for years that people develop chronic illness earlier, sometimes more than a decade earlier compared to more affluent parts of the city. This includes earlier cases of heart disease, respiratory illness and diabetes, as well as a lower life expectancy. This is not about genetics; it is about systemic inequality. What did the State do in response? It tried to close down the GP Care for All system in Summerhill. The residents, who have all the issues we have laid out before, and the doctors had to take placards and signs and stand outside their practice and had to come to Dáil Éireann, just to have the basic necessity of a GP care service maintained and not have the added anxiety they may lose it. We are asking them to firefight deprivation without the tools and now we are asking them to firefight health inequality. This is why the Social Democrats are calling for a DEIS for GP scheme, deprivation-weighted capitation rates and a cap on list sizes, so doctors in areas like Dublin Central are resourced for the reality they are working in. Our current funding model recognises age but it does not recognise deprivation. Capitation increases at the age of 70. In the north inner city, however, many patients present with the health profile of a 70-year-old at the age of 50 but the system is not funded in that way. Equality is giving everyone the same. Equity is recognising that some communities start further back. The north Dublin GP training programme started in 2011 with Dr. Austin O'Carroll and it is a model that works. Deputy Rice has given 20 points on what could improve our GP care system across the country. We hope the Minister of State will take it on.

Gabhaim buíochas leis an Teachta. Bogfaimid ar aghaidh chuig sliotán an Rialtais agus an Aire Stáit, Kieran O'Donnell.

Ciarán Ó Domhnaill. I welcome the opportunity to engage with colleagues on the important matter of expanding access to general practice care. I wish to thank the Social Democrats for raising this issue, and Deputy Rice for leading on the motion. I am taking this debate on behalf of my colleague, the Minister for Health, Deputy Jennifer Carroll MacNeill, who is travelling to the EPSCO meetings today. The Government will not be opposing the motion. We are all aware of how central general practice is to the provision of healthcare in Ireland. For the majority of patients the GP is the primary care provider, acting as the first point of contact for most health issues. We all know that GPs provide an invaluable service. GPs help to direct the care of their patients, acting also as the gatekeepers to other primary care services and the wider healthcare system. Indeed, central to the Sláintecare vision is a more community-centred healthcare service, which Deputies have name-checked, with care provided to more patients closer to home in primary care settings. Access to GP services is essential to realising this vision. GPs provide care to patients over their entire lifespan. They develop patient-doctor relationships that improve the service provided through a greater understanding of the patient and their health needs. At times of serious illness that relationship is of particular value as the trust built up over time is of enormous assistance in both recognising health issues and in helping patients to manage them. In the case of older people, the relationship often carries even greater weight. All people aged over 70 have access to GP care without charges, and by virtue of this have access to the full range of GP services, including the chronic disease management programme, which I will speak about more in few moments. Having said that, we recognise that the Government needs to continue to improve access to GP services, particularly in underserved areas and more remote rural areas, to meet the growing demand for GP services. Increasing access to GP services is largely dependent on increasing our GP workforce and the programme for Government commits to increasing the number of practising GPs. Significant work has already been undertaken in this regard, to increase GP numbers and improve access to GP services. To make general practice in Ireland more attractive as a career, and to increase the level of services provided to patients, investment in general practice has been increased by over €340 million under the 2019 and 2023 GP and general medical services, GMS, agreements. Both agreements increased payments to GMS GPs and increased the range of supports provided to GP practices. Under the 2019 GP agreement rural practice supports were increased and a support for practices in urban areas of social deprivation was also introduced. The social deprivation grant available to eligible GPs supports practices to cover the costs of additional clinical supports to meet the needs of patients within the practice from socially deprived urban areas. The 2019 agreement also introduced the GP-led chronic disease management, CDM, programme. The programme is well regarded by patients and GPs, and helps to bring care for chronic disease further into the community. It has been successful in shifting care away from hospitals, with over 90% of patients on the programme managing their conditions in the community. In 2025 alone, over 650,000 GP-led patient reviews were provided under the CDM treatment programme, including approximately 400,000 reviews for people aged over 70 years of age. Work is under way to expand the conditions covered under the programme to include chronic kidney disease and familial hypercholesterolaemia. Further expansions of the programme would require careful consideration and consultation with GPs. First, we need to be sure that we have the capacity in place to manage any expansion in eligibility. In addition, we need to recognise the unique relationship that is at the heart of the programme when it comes to determining which clinical conditions it can best serve. The programme requires active engagement on the part of patients to manage their conditions, in co-operation with the GP and the GP nurse. Any additional clinical conditions to be added would have to be amenable to this approach. Almost all GP practices are digitalised. The 2019 GP agreement also sets out measures agreed in relation to the further digitisation of health services and GP engagement with these initiatives. More recently, GPs have used digital solutions to switch from paper to electronic prescriptions, for electronic referrals to hospitals and for managing the sharing of patient data under the CDM programme. The 2023 GP agreement introduced a new grant for additional practice staff capacity and a support for staff maternity leave taking. It also introduced a locum sourcing support for rural GMS practices. These measures have helped to make working as a GP in Ireland increasingly attractive to doctors, and the positive impact of this is being seen in the number of GPs undertaking GP training. Medical graduates are showing an unprecedented level of interest in general practice, with record numbers of graduates applying for GP training in recent years. The 2023 agreement also provided for the expansion of eligibility for a GP visit card from children under six years of age to all children under eight years and to all those earning up to the median household income. In the limited time I have I want to cover certain areas. With regard to strategic planning for GP services, a strategic review of general practice is currently under way led by the Department of Health and with support from the HSE. The review, with stakeholder input, is examining a range of important issues affecting general practice, including issues around GP capacity, the reform of GP out-of-hours services, possible improvements to the GP training system, and the need for further and revised GP supports. The potential for HSE-employed GPs, as well as other possible measures to bring more GPs to underserved areas, is also being examined. Significant progress has been made under the review, which is to be completed this year. The report will identify the arrangements necessary to improve the current system of GP care. While the existing GMS-GP contract has been significantly updated under the 2019 and 2023 GP agreements, and via circular, it is acknowledged that a new contract should be developed. The findings of the strategic review will serve as a blueprint to bring forward a new, modern GP contract. Work is also under way in other areas to improve the level of GP service provision. For example, a comprehensive women's health programme in general practice is also being developed in line with a relevant programme for Government commitment. A strong pipeline is in place for the continued construction of primary care centres, which serve as ideal locations for the provision of GP services alongside other primary care services. The common conditions service, CCS, recently commenced enabling community pharmacists in Ireland for the very first time to provide advice and treat eight common conditions. This private service is accessible to all patients and will help reduce the need to attend GP practices for the eight conditions. I would like also to address the amendment to the motion tabled by Deputy Sherlock. The Government is fully committed to supporting the balanced delivery of GP services. Although not set out in legislation, it is accepted that GP services should be delivered at the local level, and that where possible service provision should be sufficient to meet local demand. To this end, we provide additional supports to practices in rural areas, and since 2020 have provided additional supports to practices in areas of urban deprivation. The 2023 GP agreement introduced additional supports for staffing, enabling GPs to take on additional health and social care professionals to aid their patients. The strategic review of general practice will further address the issues of delivering a balanced GP service able to meet the needs of patients at the local level. However, the Government has concerns about how the Health (Availability of General Practice Services) Bill is currently set out. In the first place, there is a lack of clarity around the terms of the Bill. No attempt is made in the Bill to define what a fair and equitable distribution should be or what constitutes the social determinants of health status. The Minister and the Government are fully aware of the impacts of social deprivation on health status. While the Bill brought forward by Deputy Sherlock relates only to GP services, the Government is focused on building fair and equitable access to all services. We will continue to work towards that goal. It is difficult to see how the HSE could fulfil the legal obligation that this Bill would impose without clarity around the additional expenditure that would be required. For these reasons, the Government will oppose the amendment to the motion tabled by Deputy Sherlock. The Minister for Health and the Government fully recognise the important work of general practice. We have invested significantly in general practice to increase GP capacity and to provide for increased supports for the provision of GP services. There are an estimated 4,000 GPs practising in Ireland. As of this month, there are 3,237 GPs with at least one HSE contract, an increase of 9% from 2020. The recent increase in GP training places and the ongoing recruitment of GPs under the international medical graduate, IMG, programme will see the number of GP practices across the country increase, while the strategic review of general practice will set out further measures to be taken to support and grow our general practice services over the coming years. The Minister for Health and the Government understand the need to expand access to GP services and have undertaken measures that reflect many of those proposed by the motion. As already stated, the Government does not oppose the motion. I ask that the other areas that I did not have an opportunity to deal with in my speech be read into the record.

Before I call the next speaker, I welcome to the Gallery Mr. Gerry Reilly, president elect of the Institute of Guidance Counsellors, and Ms Valerie Fitzpatrick, the vice-president elect. I call Deputy Cian O'Callaghan.

I thank my colleague, Deputy Rice, for all the work he has done on this motion. Is minic a thagann Airí isteach anseo agus léann siad ráiteas atá ullmhaithe, gan mórán ionchuir ón Aire féin. Ar chúis éigin, shíl mé go mbeadh an tAire Stáit, an Teachta O’Donnell, difriúil ach bhí mé mícheart. It is welcome that the Government is not opposing the motion. There are some very good ideas and suggestions in this motion that the Minister of State did not even address in his contribution. It is disappointing that he did not address them. I want to read to the Minister of State from the survey that was carried out by Deputy Rice. It sums up a huge number of the problems in terms of the lack of capacity, solutions for which are in our motion and which urgently need to be addressed. One respondent said they filled out the survey for their 73-year-old mother who is suffering with chronic illness, such as heart failure and dementia. Two weeks ago, the respondent said, they found her crawling out of her room on her hands and knees because she had fallen and could not get herself up. When the respondent rang the mother's GP to ask for an appointment to get her referred to age-related care for physiotherapy and walking-aid assessment, the appointment given was for 18 March. The respondent rang on 13 February and the appointment given was for 18 March. The respondent's mother was recently discharged from her heart failure unit to GP care. If she has a future heart failure episode, she is meant to wait for five weeks for GP assessment to refer her back in. The respondent said they will end up back in the accident and emergency department to wait on a trolley or bed for another 56 hours. That is the reality facing people in Ireland because of the chronic lack of investment to improve GP capacity and primary care. There are a number of solutions in the motion that the Minister of State did not address. One of the key measures put forward is the introduction of a salaried GP model so that GPs are directly employed by the HSE. This would remove the burdens of effectively running a small business. The motion calls on the Government to ensure proper cover in rural communities, on offshore islands and in areas of deprivation. It suggests the creation of a DEIS-like scheme for GPs to increase capacity. It suggests the expansion of locum cover supports and calls for investment in a national GP clinical lead role. It suggests investment in a primary healthcare equity working group and to establish same, with representation from front-line services and patients in deprived areas, similar to the successful Scottish model. It calls for the acceleration of the delivery of HSE-built primary care centres. The Minister of State did reference that part of the motion but did not go into any detail about what extra is being done in that regard. The motion also calls for the development of a national strategy to attract, support and retain future GPs. It calls for students to get increased exposure to general practice in medical schools. It calls for accelerated implementation of the 2023 report of the Irish College of General Practitioners entitled "Medical Student to General Practitioner — An Urgent Call to Action". It calls for the provision of an additional 100 GP training places. Those are urgently needed. It calls for the alignment of the terms and conditions for general practice nurses with those of their HSE colleagues. It calls for an increase in the annual public health nurse training capacity from 160 places to 240 places. Those are the concrete and detailed proposals we have put forward. The Government is not opposing them but the Minister of State has not told us in concrete terms what it is going to do to implement them.

I thank the Minister of State for his response. Like my colleagues, I commend the work of Deputy Rice in the lead-up to this motion and in presenting a motion which, as Deputy O'Callaghan said, is not opposed. We still have as many questions as we have answers about the implementation of the motion. The irony, as we all truly know, is that you have to plan two or three weeks in advance if you need a GP appointment. That is the case throughout this country. You have to let your GP know or build into the timetable for your family at home that you might need an antibiotic, a consultancy, some advice or professional experience well in advance of actually having any symptoms. If you leave it until you are symptomatic, you will quite often not get an efficient appointment. That is no reflection, as we know, on the wonderful work of our GPs. If Kildare is a snapshot of what is happening around the country, there are upwards of 3,200 people per GP. That is simply unsustainable. There has been a population surge in Kildare over the past 30 years. It has increased from 120,000 or 130,000 to 250,000. The one thing we can all be absolutely sure of is that while the population has increased, the incredibly important services, such as GP access, have not risen in a similar fashion. What we do not see from this response or in the Government's ambition is any sort of urgency. We are not addressing the root cause of issues. The Taoiseach, Tánaiste and everyone else have criticised us for not coming forward with evidence-based proposals, constructive dialogue and plans. Here we have concrete proposals. In ways, some of the aspects of the motion simply ask the Government to fulfil commitments it set out in Sláintecare nearly ten years ago. What we are doing is trying to match ambition to need. We are not seeing that from the Government's perspective. We need a comprehensive workforce plan when it comes to GP services. We need reform. It is not a siloed approach that is necessary. We need to see the Department of housing come in here. We need to see the involvement of the Department of Social Protection. We need to see an evidence-based approach whereby when housing developments are being planned, it is not simply a childcare facility that is stipulated. What else does a community need? There are people in Kildare right now who are queuing up overnight to buy homes for €500,000 on the assumption that alongside the homes that they buy, the services they need to raise their families will be there. They are not there.

I welcome that the Government will not oppose this motion. I want to recap Sláintecare for a moment, which my party is really proud of, and the work that Róisín Shortall did and her legacy. Sláintecare was about cross-party co-operation and longitudinal vision for a transformation of our healthcare system from a two-tier to a single-tier system. This Government downgraded it from where it should have been situated in the Department of the Taoiseach to the Department of Health, where it could never fulfil its vision and ambition. Since then, the Government has cherry-picked what it wants, and not what the pubic wants or what was in the cross-party agreement. That is really important to recall in this moment when we are simply asking the Government to fulfil some of the elements of Sláintecare. We heard in the Minister of State's comments a great deal about progress, investment and reform. If that progress was real, people around this country would not be waiting for weeks for GP appointments. We would not be here pushing a motion to implement the Sláintecare programme, and we would not be the only country in Europe without universal primary healthcare. The unfortunate reality is that there is a two-tier health system here in Ireland and most people are paying on average between €50 and €90 for a GP appointment. For the 42% of people who have medical cards, healthcare is delayed, with appointments only available often after weeks or months, and that is if people can even get registered. Last week, we ran a survey to gather perspectives on people's experience in this area. I will quote two of the damning responses which demonstrate the real impact that this Government's inaction has had. One stated that trying to get an appointment is like winning the lottery, and that they are always busy. Another, which is particularly concerning, stated that in the time it took the person to secure a GP, they timed out on a prescription for medication they used to take daily to treat depression and anxiety, and they just had to learn to live without them. That is just a sample of the 600 responses we received about the inadequacy of GP services in this country. One of the key recommendations from Sláintecare was universal GP coverage by year five of implementation. This is a policy that the Government has already agreed to enact, yet eight years later, we are no closer to that goal. Our neighbours across Europe have proven that it is possible, and we have the path to get there. It is to create a new DEIS for GP scheme, develop a new GP contract, adapt to modern working needs, and expand free healthcare for children aged at least 12 years. We do not lack the solutions. We lack a proactive Government with the ambition and urgency to enact systematic change. Last year, the Minister for Health launched the strategic review, but that review is just the latest delay in a series of delays from a Government led by two former health Ministers, who seemingly want Sláintecare to collect dust while ordinary people go without care. Access to healthcare is not a policy to be debated. It is a fundamental human right to be respected. This motion is about fulfilling that right and addressing people's health needs in the community. I congratulate Deputy Pádraig Rice on his good work.

I commend Deputy Rice on tabling this motion. GP care and GP services are an important issue. This motion is about something very simple but also important, namely, that when people need to see a GP, they should be able to see one, and they should not have to worry about whether they can afford it or not. GPs are the backbone of our health service. The GP is the first person most people turn to when they are sick, worried, pregnant, struggling with their mental health or managing a long-term illness. I am a great advocate for our primary care system and GP service. We all know that the family doctor, family GP and family practices we have in this State are really important. They work. They are a person's gateway into the health services. Everybody knows their GP and most people trust their GP. They are the referral pathway on to other services. The problem is that we need more GPs, just as we need more staff in almost every part of the health service. I know from talking to recruits who have come out of training that it is sometimes daunting to be an independent general practitioner and, on occasion, maybe going in and working in a private practice, but working for that practice. The thought of being an entrepreneur, setting up a practice, being an employer, dealing with the bureaucracy, the paperwork, regulations and the HSE is daunting and a real challenge, while GPs are at the same time trying to provide services. That is why the notion of a public GP contract is important and needs to be taken up. We called for this strongly during the election campaign. It was in the health plan that I launched before the election. The current Minister for Health, who was, for a short time, the health spokesperson for Fine Gael, said it was something she would look at. There are vague references to it in the programme for Government, but we need more because this is about choice. It is great if people want to become independent general practitioners. They should be supported and, as I said, I am an advocate for them. For those who want to work in the public system and simply want to be GPs, however, public contracts should be provided. This is all the more relevant when it comes to the cost of GPs. We all signed up to Sláintecare. Most parties signed up to it, not just in principle but because we believed in it, ideologically but also practically, and we know that a barrier is the cost of GP care. I am not so sure the same can be said of the Government when we look at its track record on Sláintecare. In recent times, we have seen what is happening with the elective hospitals, and also with free GP care. The previous Minister for Health announced 400,000 additional GP-only cards. The process was so complicated and convoluted. I do not know if anybody has gone and looked at it. It is almost impossible to say to people whether they are entitled to the card or not. That needs to be simplified because many people who are entitled to a GP-only care do not have one because they are just not aware that they are entitled to it in the first place. That, to me, is crazy, but maybe it is intentional. An awful lot more needs to be done. I raise a local issue that Teachta Conor McGuinness raised recently, namely, the need for a primary care centre in Lismore in County Waterford. Unfortunately, that is back to the drawing board. The preferred bidder, the contractor, pulled out because of the viability of the project, which means it is back at the starting block again. I ask the Minister to take that up with the relevant officials in the HSE. That project now needs to be seriously looked at. I visited the area with Deputy Conor McGuinness a number of times in recent years, and I know how much it is needed for the people of Lismore. There are also healthcare projects in Tallow that need to be funded too. There is a clinic there that has an application for capital funding which still has not been progressed. I could mention many projects in Waterford city too. On the thrust of this motion, many areas of general practice are working well and I am a big believer in the relationship between GPs and community care. All of the supports and additional services now being provided in primary care centres and the chronic disease management teams mentioned in this motion are important and they work. Where things are working, we need to work with GPs so that they can deliver those services. I was dealing with one GP in Waterford city. Five years ago, the HSE told him it wanted more space to provide some of these services. He jumped through every hoop and over every hurdle and to this day, there has not been any finality to that. The bureaucracy is ridiculous and needs to be addressed. I commend again the author of the motion on bringing it forward.

There was a time when every town and village had a family doctor. They were rooted in the community and known to everybody across generations. Today, that model is under real strain in urban areas but particularly in rural Ireland. GPs are the anchor of our health system. They are the gateway into our health system in most cases. They provide long-term, continuous care from cradle to grave, yet successive governments have failed to plan properly for primary care. In 2001, the Future Together report warned about shortages in GP numbers and practice-based staff. Twenty-five years later, we are still playing catch-up. The rate of GPs per head has barely improved in that time and is now moving in the wrong direction. The number of practising GPs fell from 4,583 in 2019 to 4,420 in 2022. One in four GPs is aged over 60, so there is another crisis coming. Only one in five practices is open to new public patients. In County Waterford, the impact is really clear. In Dungarvan, people struggle to secure timely appointments. In Portlaw, access is restricted during the week and there is no full-time availability. The issue in Lismore with the primary care centre that is now delayed has been mentioned. It is back to the drawing board and the starting blocks, through no fault of the people of Lismore or anybody practising medicine. The Government needs to get to grips with that and expedite that process. Across villages and country areas, older people and people with disabilities are travelling well beyond their own communities for routine care. That is creating an additional burden and barrier. People in Dungarvan, for example, have to travel a couple of towns away. It is simply not sustainable. GPs work exceptionally hard. They are dedicated and committed. None of this is at their door. It is clearly at the door of the Government. GPs are under huge pressure. They are operating with the lowest levels of practice-based staff among comparable countries. They are increasingly expected to run complex small and medium enterprises while trying to provide front-line care. As Deputy Cullinane said, those GPs who we are talking to, whether here in Ireland or abroad, are telling us that they do not want to be entrepreneurs. They do not want to run businesses, by and large. They want to provide care. That is what they studied. One said to me that if they wanted to run a business, they would have done an MBA, not a medical course. Our approach is really straightforward. We would increase GP training places from 350 to 450, lift the recruitment cap for front-line roles and expand the multidisciplinary primary care teams. Investing in primary care is efficient. It is probably the best way to spend money in the health service, so if we are serious about rural Ireland, access to GP care must be available in every town and village.

Access to a doctor is a necessity and a basic right for people, especially when they are sick. However, a GP shortage in south Wicklow and north Wexford has reached crisis point. I ask the Minister to intervene. People are desperate. They are travelling more than 20 km but still cannot find a GP who will accept new patients. One practice in a small town in my constituency has a waiting list of 200 people and that list is currently closed. We have seen rapid population growth, particularly in north Wexford, the Gorey-Courtown corridor and parts of south Wicklow. I ask the Minister to consider introducing interim measures immediately to ensure people can access basic care. I had a recent case of a woman with a high-risk pregnancy. She came in desperation to my office because she could not secure a GP anywhere. This should not be happening. It is crazy. As a result, hospital accident and emergency departments are being used as a stopgap. It is unsafe, unsustainable and places even greater pressure on emergency staff, contributing to longer waiting times. Private patients currently have no mechanism for GP assignment through the HSE. Families are unable to register infants, creating risks for children's health. I have constituents in south Wicklow who are registered with one GP but must register their infant with another, in some cases, on the far side of the county or even across the county boundaries. As has been pointed out, Ireland has one of the lowest GP-to-population ratios in western Europe but Wicklow and Wexford are officially designated by the Government as pressure zones for GP practice and capacity. We are not training enough GPs to replace retiring doctors and their conditions need to improve if we want to keep graduates here in Ireland. We are losing them rapidly. For those with medical cards, the HSE may be able to arrange a GP but private patients have no such support. They must navigate an overstretched, largely private system on their own. This system has to change because lives will be lost. I ask the Minister to personally intervene.

For six years, SouthDoc, which provides the out-of-hours service in Cork, has done everything to remove its offices from the northside. In 2021, following a very strong public campaign, we got SouthDoc on the northside reopened. However, in the past number of years, services have been reduced. In January, a miracle happened. SouthDoc in Blackpool reopened. The reason was that the tender is due at the end of this month, so it was reopened because SouthDoc wants to get the tender again. The service is not going out to public tender; it is being renewed. I want a guarantee from the Minister that SouthDoc in Blackpool will remain open and will not be shut down next month. Another out-of-hours service, a private one called NorthDoc, has opened. My wife and daughter had to use it last weekend. They got an appointment within half an hour and they were in and out within 20 minutes after my daughter got what she needed. They were private patients. The service is not open to people with medical cards, who have to wait weeks to get an appointment with a doctor. They have to travel over to the Kinsale Road on the southside if they cannot get an appointment in Blackpool and then they cannot get access to NorthDoc because they are on medical cards. This is not good enough. People should have a right to attend GP services out of hours. Does the Minister know what else is happening? Some people cannot afford to go over to the southside and have told me they could not afford a taxi. What did they do? They went to the Mercy University Hospital accident and emergency department, which is the one place the HSE do not want people to go because accident and emergency departments are out the door already with overcrowding. This Government's inability to tackle SouthDoc and keep the clinic in Blackpool open is driving more people into accident and emergency departments. The people of the northside deserve to have an out-of-hours service. People are waiting weeks to see a GP. People with a medical card should not be treated like second-class citizen. Everyone has a right to attend a GP. I ask the Minister for that commitment today.

I commend the Social Democrats on bringing this motion forward. I am very happy to support it. The shortage of GPs in my constituency of Louth has been long flagged, yet the issues remain. Last year, my party colleague flagged that County Louth was currently facing a critical shortage of general practitioners, with reports indicating that it had the highest number of medical card holders in Ireland waiting to be assigned a doctor. Prior to that, a study by the Irish College of General Practitioners showed a 2.8% reduction of the number of GPs in Louth. This is at a time when we are seeing huge population increases throughout the county, in Drogheda, Dundalk and Ardee. Because people cannot access a GP, we have seen several calls in recent months from the management of Our Lady of Lourdes Hospital in Drogheda for the public to avoid emergency departments unless absolutely necessary due to the severe overcrowding and, in some cases, extremely high patient numbers. What a great country we have when we cannot provide timely medical care. The ratio of GPs to population is estimated at seven per 10,000, which indicates slow progress. As outlined by my colleagues, the number of actively practising GPs is falling year on year. It is estimated that one in four of these doctors is over 60 years of age, which poses a huge problem coming down the tracks. It is just not good enough. Consistently, in our annual alternative budgets, Sinn Féin has offered costed solutions to all of these issues. The Government's response is to do something, if anything, but not the right thing. To begin to solve this crisis the Government needs to immediately increase the number of GP trainee entrants from 350 to 450 and support the Irish College of General Practitioners to expedite training, where appropriate. We need to increase training places across medical, nursing and allied health and social care professions, lift the recruitment cap for front-line roles and double the recruitment target for 2024 to expand the multidisciplinary, primary and enhanced community care teams. The solutions are there but, unfortunately, the do-nothing approach by successive Governments is having a detrimental impact on people's lives.

I thank the Social Democrats for bringing forward this motion, which we fully support. It is an issue we all deal with every single day. For most people, their GP is the first port of call when they have illness in their family. However, GP practices are struggling to deal with demand. We have situations where people have to plan to be sick before they can get an appointment. The primary healthcare system has to support quality, scheduled and urgent access to clinicians in order that patients and their families can build a trusting relationship with their GPs. However, the policy implemented by the Government has broken down these relationships over the years. We have people who become eligible for medical cards because of their advanced age being removed from their GP practice list because the quota has been reached. Then, at 66 or 67 years of age, they have to look for a new GP to sign up with. They are finding that difficult because all of the GP practices are oversubscribed. I am dealing with an 85-year-old man from Swords who requires blood tests every two months. The next fasting appointment he can get is in Beaumont Hospital to which he would have to take two buses while fasting. His second option is the Mater Hospital, which would require him to take one bus. While that is more manageable, the hospital has no available appointments. The man in question used to get his blood test done in St. Joseph's Hospital in Raheny but that facility is no longer available. There is a walk-in service in St. Vincent's University Hospital, which again means taking two buses and a Luas, but this is too far for him to travel. We are talking about an 85-year-old man who has a requirement for blood tests. He can avail of a blood test with his GP but he only has a GP card, so it would cost him €40 every time he has one done. He is struggling with the cost of living and he cannot afford to pay this. We have a population of 41,000 in Swords, of whom 10% are aged over 65 years. There should be a free blood testing service in place for people in Swords. The Government should ensure the new public primary healthcare centre in the town, which will be accessible to people in the wider Fingal East area, will have a free blood test service for people. Epilepsy Ireland works with over 45,000 people living with epilepsy across the country. It is a common condition, and while some people will need continued access to special care, others can be appropriately managed by primary care closer to home. Epilepsy Ireland is asking the Government to expand the chronic disease management programme to include epilepsy. I fully support that request.

I will start with some good news for a change. However, it is good news that is tainted by bureaucracy getting in the way of progress. The Government needs to look at the process for having new GP services take on medical card patients. The bureaucratic red tape within the HSE makes this really difficult. I have had this experience over the last couple of years in trying to help a new GP service in Rowlagh. I have been working with Dr. Kumar and his team from day one to get approval from the HSE to allow the practice to take medical card patients. That process took over 18 months. The clinic was able to see private patients since opening but could not take on medical card patients. An 18-month wait to be able to do so is unacceptable. It needs to be looked at as a matter of urgency. I was delighted to see it finally being approved. It will allow the Rowlagh Medical Centre to take on an initial 1,000 medical card patients. It also has capacity for more. At a time when GP services are in short supply, this is wonderful news for the people of north Clondalkin and beyond. The centre opened its doors in 2024. Since then, it has seen over 10,000 patients. It has a walk-in service, which also needs to be looked at. You do not need an appointment to see the GP. You can just walk in. Other GP surgeries in the area do not offer that service. The centre also provides an out-of-hours service. It is open from Monday to Sunday, seven days a week. People have said that other GPs might be a bit put out by this competition but my own GP, who is listening to this debate, is quite happy to see this service because it is talking pressure off them. They are inundated with people seeking to access their services. As I have said, this is a good news story for the people of north Clondalkin and the surrounding areas but there is also a bad news story. We have been promised a primary care centre in Rowlagh for over 15 years. At the very start, there was an issue with a land transfer between the Department of education and the Department of Health. This saga has been going on for way too long. It is an area of high disadvantage. The Pobal index will tell you that; I do not need to stand up here and say it. The area has been crying out for this centre for a long time. The last response I got from the Minister was very disappointing. It basically said that plans are on hold. We have been waiting for 15 years and the plans are now on hold while the Department looks at the needs of the area. I can tell the Minister of State the needs of the area. I live there. My constituency office is in the heart of the area. I know the people who come to me looking for access to GPs, mental health supports, physiotherapy and all of the other things offered as primary care. We need to see this primary healthcare centre in place as a matter of urgency.

I move amendment No. 1: To insert the following after "and investment in analytical capacity": "; further recognises that: — the inverse care law and unequal access to GPs is giving rise to stark inequalities, delayed diagnosis, poorer health outcomes, and increasing upward pressure on the hospital system; — recent extensive research by the Labour Party on GP-to-patient ratios has highlighted significant inequalities, and found that there is one GP per 1,390 of population in Clontarf in Dublin 3, yet in Cabra in Dublin 7, the ratio is one GP to 3,060 of population; — suburban areas of significant population growth are struggling with a lack of GP services, with East Meath having one General Medical Service GP for every 5,090 people, a divergence of 3,331 from the national average; and — the 2025 Economic and Social Research Institute projections, of national demand and workforce requirements for general practice in Ireland, also show there will be a demand increase of at least 23 per cent by 2040, requiring up to an additional 761 to 868 General Practice Nurses, alongside increased GP numbers; and therefore, further calls on Government to support the passage into law of the Health (Availability of General Practitioner Services) Bill 2025, to provide for a direct statutory link between the HSE's assessment of the level of need for primary care services in specific areas, and the level of service provided.". I thank Deputy Pádraig Rice and the Social Democrats for bringing forward this really important motion. This issue has been very close to my own heart for a number of years. It is something we have spent a lot of time talking about over recent years. While there has been a little bit of progress with regard to the chronic disease management programme over recent times, the fact remains that the Department of Health does not have a consistent overview of the first point of access to the healthcare system in this country, that is, the GPs. That is wrong. It is an anomaly we see in hardly any other country across the European Union but we see it in Ireland because we have a public system of hospital care and an effectively private system of GP care. The Government has been promising a strategic review of GP care for a number of years now. It was supposed to be published last year but we have yet to see it. Where is it? Will the Government please publish it? I will move onto a second key thing. At the height of our rushing through of Covid-related legislation, back in 2020, I stood in this Chamber as a Senator when the then Minister for Health, Stephen Donnelly, legislated for free GP care to be expanded to those under the age of 12. That is still not in place six years on. Billions of euro have been generated for our public finances and yet the Government has not managed to get its act together on this. Expanding access to free GP care is one thing. We in the Labour Party are passionate about it. The then Minister of State, Kathleen Lynch, introduced free GP care over ten years ago. That was the starting point. At that time, free GP care was provided for those under four or six. If we do not increase the number of GPs on the ground along with expanding universal access to GP care, which is at the core of Sláintecare and which we are passionate about, we will end up replicating the inequalities of our hospital system. People will end up paying to leapfrog the GP system. We need to make sure we have more GPs on the ground. There have been initiatives on the part of the HSE and the Department of Health such as the arrangement with South African doctors and the increase in the number of GP training places. However, it is incredible that the Department of Health still does not have a clear idea of the unmet need for GPs or a precise picture of where GPs are located across the country. Last year, my office spent six months trying to get information on the number of GPs across every community health network area from the HSE. It was shambolic. Some areas were really on the ball. Other areas did not know. It took six months to put that data together. I am delighted to hear that the Social Democrats are using that data. I am sure anybody with intellectual integrity in the party will credit the source of that data. The key thing is that the Department does not know where the unmet need is and does not have an ongoing overview of where GPs are located across the country. That is wrong. That is why we brought forward that Bill last year and why it is scandalous that the Government is now opposing our amendment, which would ensure that the HSE would take responsibility for at least looking at where GPs are located across the country. We can have all the motions in the world about the need to improve GP services but we will not ensure we have a proper number of GPs in place for the communities I represent in Dublin Central and for communities in Kildare, Limerick, Cork city and elsewhere if we do not change the legislation to ensure the HSE takes direct responsibility. The reality is that not every community is the same. The Pobal deprivation index states that people in some of the most deprived communities are four and a half times more likely to have poor health outcomes compared with the average community. Part and parcel of that is access to GPs. In the community I represent in the north inner city, there is one GP for every 3,500 people. In Cabra, there is one for every 3,000 people. In other parts of the country, it is not an issue. If you ring up to look for a GP appointment you will get one within a few days. I know of a 50-year-old woman who went to her pharmacist and was told she had shingles. She rang her GP for an emergency appointment and was told she would get one the following week. A man came to me last year who should have presented with very worrying symptoms of prostate but, because he was being given appointments two weeks out, he kept on putting it off because of work and other commitments. He should have been able to pick up the phone, say he had a problem and be seen in a timely manner. This is a real issue in certain communities, although not in every community across the country. The key thing is that, if we have more people on the ground, we can begin to resolve all of the issues we have with regard to our acute hospital system, including the Mater being the GP service for many people in the inner city because they cannot access a GP. The other key issue I will raise today has regard to the GMS scheme. It is effectively weighted towards women of child-bearing age and the older population. The national average life expectancy is about 82 but, in one GP practice in my constituency, Summerhill Family Practice, part of the GP Care For All network, it is just under 60. That speaks volumes about what is happening on the ground.

I thank the Social Democrats and Deputy Rice for bringing this motion forward. I will primarily focus on one aspect of the motion. The motion calls on the Government to "expand the ... [chronic disease management programme] to include severe and enduring mental health difficulties, epilepsy and other conditions as appropriate, in consultation with GPs delivering the service". I am an epileptic. That is something I have learned to live with but that would not have been possible without the support of my consultant, the epilepsy nurses in CUH and, very importantly, my own GP. Early last year, I attended and spoke at an event in UCC organised by Epilepsy Ireland. There was a section titled "Is it time for Epilepsy to be added to the Chronic Disease Management Programme?" I played a very minor part in the event. There were healthcare professionals, advocacy groups and people living with epilepsy there. The resounding answer to that overall question was "Yes". Epilepsy is an incredibly common condition. While some people need access to special care, others do not. However, it is still important that we have continued access to health services. A study conducted by University College Cork and Epilepsy Ireland investigating the relationship between people with epilepsy and their GPs found that GPs and people with epilepsy described a limited role for GPs in epilepsy care. There were varying levels of engagement from people with epilepsy with their GPs and vice versa. Limited knowledge of epilepsy was cited as a challenge for GPs working in family practices. It is a strongly held belief that if epilepsy were to be added to the CDMP, it would help improve these attitudes by encouraging GPs to upskill their knowledge of epilepsy and, ultimately, this would help to relieve pressure on already stretched specialist epilepsy services, leading to better health outcomes for people with epilepsy.

I welcome the Minister of State to the House today. I thank the Social Democrats for raising this very important motion. The average GP to patient ratio in south Kildare - the area I represent - is 1: 3,163, the fourth highest in the country. Not a week goes by that I do not get somebody in my office asking for a GP. A lot of this has to do with people who have come from Dublin and other parts of the country and who cannot find a local GP. One of the biggest problems is that, in the main, many of those people retain their GP in Dublin and when an event arises and they have to bring a sick child or even present themselves, they travel 60 km to Dublin to visit their GP because the GP quota in Athy, Kildare town, Monasterevin and Newbridge is already full. It is simply not good enough. The Minister of State can imagine putting a child into a car to visit a GP. As a result, in the main people are now going to the outpatients department in Naas and Portlaoise hospitals, which is causing more congestion in those hospitals. I want to raise the out-of-hours service with the Minister of State today. I have been consistent in calling for the KDOC service to not alone have an outlet in Naas, as it does, but also to have an outlet in south Kildare. There is no doubt we have an absolutely fantastic primary care centre in Athy. We are very proud of it. There are lots of services there, but at the moment KDOC does not administer services through the centre in Athy. We have been told it will be an on-demand service. That is simply not good enough. I ask the Minister of State to go back to the HSE and the Department once again to ask for an extension of the KDOC service, as I have called for in this House before, to the town of Athy. GP services are so important for the social infrastructure of this country, particularly in Kildare South.

Early access to primary medical care GP services is a fundamental basis for a good quality, safe and effective health service. GPs play a very important role in looking after patient care, ensuring early intervention and providing care in the community. I compliment the excellent service provided by GPs, practice nurses, therapy staff and administrative staff in GP practices right across the country. GP services are under severe pressure. Many GPs are overworked, burnt out and increasingly find it difficult to take annual leave. The service needs support and it needs reform. The Economic and Social Research Institute suggests that 1,200 new GPs will be required by 2040. The Irish College of General Practitioners put that figure much higher, at 2,000, due to an ageing population and population growth. The World Health Organization recommends a ratio of one GP to 1,000. The ratio in this country is almost double that, at 1:1,750. In some areas, as has already been said, it goes as high as 1:3,500. Rural areas and areas of deprivation are worst served. A third of the population of the country live in rural areas but only 10% of GPs work in those areas. A substantial number of GPs are now heading for retirement. There are something like 600 over 65, with half of those - 300- aged over 70. As a result of all that, as was recently shown in a report, it is difficult for new patients to be registered. Two thirds of practices in rural Ireland are not accepting new patients and, generally speaking, it is about half. I see that almost every day in my constituency office where people are coming in saying they cannot get registered with a GP. Increasingly also, patients are finding that it takes a week or more to get a consultation. The situation needs to be tackled. Anything up to 200 additional GP training places must be provided through an expansion of the current scheme in hospitals, training in GP surgeries and on GP training schemes. That will not solve the problem. In particular in rural and deprived areas we need GPs to be directly employed by the State through the Health Service Executive. That service should be rolled out initially in rural areas, where it is almost impossible to get replacement GPs. We have regularly seen in south Tipperary that when a single-handed GP retires, the vacancy is almost impossible to fill. In one case I recall it took over 18 months to fill a vacancy. The roll-out of that type of direct GP service must increasingly focus on areas that are underserved, such as deprived areas. Many GPs are now finding it difficult to take annual leave and that is something that needs to be tackled as well. A national locum panel should be established to address the situation. All health services should be provided free of charge at the point of use based on medical need. A two-tier system does not serve the public well. As a start to that process, free GP services, at least for all those under 18, should be introduced immediately by the Government.

I welcome these timely proposals from the Social Democrats. We must accept that the bedrock of any health system is having good primary care in place, and to have good primary care we need GPs. The ratio of GPs in this country is completely out of kilter with what it should be. The World Health Organization says there should be one GP per 1,000 of population. In County Laois, we have one GP per 1,700 population. More than 60 GPs are practising at any one time. In south Laois, the ratio is 1 per 2,300. The population in the county continues to rise. The impact of that is obvious. While existing GPs do good work, access is problematic, people are not getting a timely diagnosis and in some cases people do not get the treatment they need. When patients develop more complex medical problems they then have to go to hospital. Cost can be a barrier for some as a large number of working class and low-income households do not have a medical card and may not be able to afford it. Some practices cannot accept new clients. When the booklet on entitlements came out after the budget it showed that the income threshold for a medical card is €186. If a single person is on more than €186, he or she cannot have a medical card. This is 2026. We have had the same figure for more than two decades. I cannot understand why it has not changed. We have a reliance on GPs who operate private businesses. That is fine. Most of them are doing very good work. In fact, they are overworked. We are the odd one out in the European Union because we do not have salaried GPs working in primary care community centres owned by the Health Service Executive like they have in other countries. Most young newly qualified GPs do not want to set up a GP practice because they need a premises, staff, insurance, administration, utilities, etc., and then they face working an 80-hour working week for life. That is the situation that we have. They want to work in a nine-to-five job like everybody else. The Sláintecare plan was agreed by all parties nine years ago. Central to this was the provision within five years of free universal primary care at the point of delivery. Everyone was agreed on that, but we are moving towards it at a glacial pace. A range of services should be provided at primary care level. That should be expanded to include occupational therapy, physiotherapy, speech and language therapy, mental health services, diagnostics and so on. What is needed now? It is nine years since we agreed Sláintecare. We need a determined effort by the Government and the HSE - I think everybody in this House would support it - to increase the number of training places for GPs, to expand those numbers and the facilities. In addition to private practices, which we accept and which are doing good work, we need directly employed GPs. Some Ministers have talked about this in the past but then it dies away and is buried. Salaried GPs need to be employed and a scheme needs to be established. I appeal to the Minister of State to try to take a lead on this as a Minister of State in the Department of Health, to work alongside others and to have GPs in primary care centres and in the local HSE health centres, similar to the rest of the European Union. We need to set a target date for the full implementation of free universal primary care. We all know from our own work that if we do not set a target, we will not get there. We should set a target to do that. I know it will be challenging. We cannot wait and we have to start sometime. In the short term, we should expand free GP care to all workers on or below the median wage. This is really a problem, in that people who are working hard tell me that when their children get sick, they go to the doctor but that when they or their wives get sick, they cannot afford to go. That is not acceptable. Younger children, because of free GP care, can go. The fact that we do not do that means people are winding up in hospital with chronic illnesses. We need proper premises. I am going to say this to the Minister of State as a Graiguecullen person. We need a new or vastly expanded health centre in Graiguecullen. We need the same in Rathdowney and Mountrath. A new primary care centre needs to be built in Portlaoise. If we improve primary care, it will bring not just a healthier population but it will lessen the burden on the acute services because, as has been said by others, people wind up there. I know that from staff working in the accident and emergency department in Portlaoise. We have to stop the problem. It is like we are mopping the floor and the pipe is still leaking. We can deal with this at community level. This would reduce the demand on nursing home places. We would have a more efficient health system.

I am aware that GP training places have increased over the years but, as my colleagues said in the House, it has not matched the population increase. I come from a constituency that has a huge deficit of GP services, especially in rapidly growing strategic development zones, SDZs, areas like Adamstown and Clonburris, and in rapidly growing areas like Citywest and Saggart. While GPs historically have been self-motivated private operators, they have not got the assistance for the modern age. I am talking about buildings they can actually move into. Historically, the GP was in a house. They lived in the house with their family, and had a separate area where they built up their practice. If they had to move out later on, they were able to do that. There are no supports in SDZs in terms of finding affordable premises. Those sorts of supports need to be provided. Equally, there are GPs who want to work within the health service and have regular hours, even if that is weekend rosters and shifts. We need to focus on employing more GPs directly. A lot of GPs are emigrating. That is a serious issue in terms of the money spent on them and getting a return. It is also a huge brain drain. We are bringing in well-qualified imports. While we would not have a service without a lot of foreign doctors, it does not make sense to be shipping out Irish people. In that context, we need to look at improving the working conditions, providing incentives in terms of training and trying to address housing. As I have mentioned in regard to gardaí and nurses, there should be some sort of short-term gap where people can live in the area where they are trying to set up a practice as part of a shared scheme with others. Otherwise it is going to be financially unsustainable. We also need proper career pathways which they have in places like Australia and New Zealand. We do not seem to have that in Ireland. We need to look at an awful lot of the administrative paperwork as well.

This is a well-meaning motion and universality sounds great but I have problems with it. It often redirects funds from low-income families to rich families. Approximately 629,000 people are in poverty in this country. While those individuals are in poverty, I do not think we should be using taxpayers' money to pay for Michael O'Leary's children's healthcare. A woman came into my office recently with a low income. She is waiting months for an operation on her neck. She is losing the function of her hand and her leg. If she does not get this operation soon, she will have to go into care, which is an incredible situation. The funds that we have in this country should be focused on people on low- and middle-incomes. One of the reasons universality is often popular is that there is a welfare cliff and a support cliff in this country. Where we do offer supports, often the threshold is far too low, and therefore middle-income families who are struggling often fall off that cliff very quickly. If we were to do anything in terms of these funds, it is to focus on low- and middle-income earners and to raise those thresholds in terms of free access to GP services, so that there is not, in a practical sense, anybody who is not accessing healthcare because of an economic reason. The other point in this is that we are in a slow-motion car crash in terms of what is happening to GP access in this country. A total of 70% of GPs cannot take any more people onto their lists. People come into my office on a regular basis who tell me that they cannot get a doctor's appointment. I know of an individual who called a doctor at 10 a.m. By 3 p.m., he decided to go into accident and emergency. He got treated and came home. The doctor called him and said he could deal with him in ten days' time. I know of another person who spoke to 18 doctors and could not get on their lists on the day they were sick. If you increase universality in terms of access of doctors and GPs at the moment, it will reduce access to GPs currently in this system. There is no doubt about it. If you look at the figures, when GP consultations for children under six were increased, there was a 28% increase in first-year use of that system. The ESRI estimates that free GP care would lead to an additional 2.3 million GP visits annually - a 12% increase. When you do not have an increase in supply in the system, that is going to create major problems. There are two problems in terms of doctors. A total of 442 doctors were issued with temporary work visas in 2022. Doctors are voting with their feet and leaving this country. This is a fact that nobody in talking about other than Aontú, Some 51% of students in medical schools in this country are from outside Ireland and the EU. They are training here and are likely to return to their home country to practise. We need to make sure that we provide extra GP places but also for people who are likely to work in this jurisdiction.

I think we all have to admit that we stumble from disaster to disaster in this House. We had the SNA disaster last night. We have the disaster of housing with 17,000 people who are homeless in this country. Now we are talking about the disaster of GP care. There are seven GPs per 10,000 people in this country. There is a falling rate of GPs, with GPs retiring. A total of 70% of GPs cannot take on additional clients. Our population is out of control because we are ten years ahead of where we thought we would be. We have not predicted that. We are now in a situation where most of our medical students, from doctors to nurses, are leaving this country because there is nothing there for them. They cannot afford to buy a house. They do not want to be in business in this country, and rightly so. People who study medicine want to be carers for people; they do not want to be in business. We have forced GPs into that business mindset. Now we have this disaster ahead of us. Our successful Irish people in the medical profession are mainly working in the United Arab Emirates if we look at it closely. We are producing medical students but they are leaving our shores because there is nothing here for them. I want to highlight something in Cork North-Central in my constituency, and that is SouthDoc. SouthDoc has been closed from 2021 to 2026. It opened in January in order for its licence to be renewed, which is an internal renewal. If you want to go to SouthDoc on the north side of the city, you cannot get an appointment there. They do not answer the phone or will tell you the GP is out on call, so there is no point in turning up. They tell you to go to the south side of the city. Many of the constituents I represent cannot afford a taxi to go to the south side of the city for SouthDoc. That is the reality of life in this country, and certainly the reality in my constituency. Thankfully, somebody called Colin Tobin in Gurranabraher opened NorthDoc, a private practice that is facilitating people throughout the north side. He does not take medical card patients as of yet. I believe there may an application to the Department. I would hope to see that application being rushed through and being accepted so that it will be able to take medical card patients. The reality is that it is a disaster. I welcome the motion from my colleagues. I do not see it being passed or implemented. I cannot see it being implemented because the reality is we are not at the races when it comes to GP care in this country. We are way behind everywhere else in Europe. We need to move to the European model.

Our GP system is at breaking point. Every community in the country feels that. People cannot get appointments. Many cannot afford to see a doctor when they are sick. We need more GP training places, fairer supports for struggling practices and real action to keep doctors in local communities. If we want to fix healthcare, this is where we should start. I will highlight a very serious issue affecting newly qualified paramedics. For years, when paramedics completed their training with the National Ambulance Service, they moved straight into permanent positions. That is how it worked for every class before this one but, without warning, the practice has been changed. Graduating paramedics are now being kept on 16-week contracts, with no information about a permanent post or recruitment process. These are people who have worked for years on temporary contracts serving the public and believed they would have job security when they qualified. This sudden change is causing huge stress. West Cork alone stands to lose six front-line staff. I ask that this unfair situation be raised with the highest Minister in the land and resolved urgently. While we are talking about health, we have a major health crisis, whether it is in mental health or ordinary physical health. I spoke last week about Perrott House in Skibbereen but I have received no reply yet from the Taoiseach. He said he would be back to me. Hopefully, that will happen. Perrott House is down to two patients. I was told I was scaremongering when I raised the same issue last year. It had 13 patients only a few years ago, but it is being closed by stealth. The HSE is trying to do it behind the scenes. I do not know what kind of sneaky carry-on it is. It the same with the ambulance service. I raised that, and the SouthDoc service in west Cork over Christmas. The ambulance service is bypassing Bantry hospital on a regular basis because it is full. We now have a crisis situation. People are going up to Cork University Hospital, CUH. I do not want to blame any of the management at CUH or Bantry General Hospital because management and staff are breaking their butts. I saw it with my own eyes last Monday in CUH. There is a chronic situation there with patients flying in from every direction. The bottom line is patients should be looked after as much as we can and as good as we can locally. If people from Castletownbere, Mizen Head and Sheep's Head, and from Kinsale and Clonakilty, are all tearing up into CUH, we have a problem and a bottleneck. Most of them are being kept in an ambulance. When I raised that, and the SouthDoc service being closed over Christmas, all I got from Fianna Fáil and Fine Gael politicians was that I was scaremongering. I was telling the truth. I am not a fool. We know what is going on and it is not being publicised. Bantry hospital has been closed to the public on numerous occasions. It is not good enough.

As a proud member of a primary care team for 36 years, I greatly value the relationship among the primary care community of GPs, practice nurses, administration teams, OT, gerontology teams, etc. I am wary though of an increase in access at this point in time. The investment recently is most welcome. The additional places for GP training are absolutely most welcome, but if we refer back to Sláintecare and the tenets of that, there is more than just the GP piece. We have already seen a commencement and advancement in the community pharmacy agreement. Health promotion is another area, encouraging wellness and well-being, and a co-creation where we move from "I am sick. You fix me" to "I am not feeling well. Give me the tools to empower me to heal myself". A lot more work can be done in that space. That has to be explored. I worked through previously when the different age cohorts received free access, and witnessed first hand the absolute pressure that was put on GP practices and their front-line staff in trying to juggle. Coming from a commuter area such as County Meath, particularly where four GPs are retiring this year in an area with an approximate population of 28,000, I can see that pressure mounting as it is. It highlights the importance of encouraging wellness, and more investment and participation, in tandem with investment in the general practice area and in the community pharmacy agreement space. I pay tribute to those four GPs: Dr. Ursula Keane of Meadowbank in Ratoath; Dr. Paddy Tierney in Dunshaughlin; Dr. Marina Bruton; and Dr. Tom Feighery. Combined, they have approximately over 100 years, at least, of general practice service to the community of south-east Meath. In light of that, and the shortage that will be in their practices and in the towns of Dunboyne, Dunshaughlin and Ratoath, those other areas I referred to - well-being, health promotion and the community pharmacy agreement - are where we will pick up the slack, although that is probably an inappropriate word to use. That is where front-line care, accessibility, and an open door 54 hours a week, on average, for nine hours a day six days a week, augmented by North East Doctor on Call, is the gateway to primary care. In conjunction with general practice investment going forward, that is where universality will be achieved and delivered.

From listening to speakers across this House, there is clearly huge pressure on our national GP system. I acknowledge the extent of the work by Deputy Toole during the formation of the Government. The knowledge she has from her first-hand experience in healthcare is something we need to listen to. Whether it is our SNAs, teachers or any sector, the workers and the people who are on the ground know what is best. Too often, we see they are not being listened to. The clear solutions Deputy Toole has constantly raised in this House are admirable. I can definitely learn more and more. I am an engineer and do not know much about healthcare but she does. On the system, time and time again, we need to listen to those who are on the ground. I am constantly raising the issue of access to GP care in north Dublin for my constituents, who are not getting in the door as quickly as they would like. Patients are waiting way too long for appointments. I welcome the Department of Health's announcement yesterday of €26 million for north Dublin. We see accident and emergency at Beaumont Hospital finally progressing. I raised that with the Minister recently. It went to design phase in 2025-26 but it needs to go to tender and to market as soon as possible. People who cannot get their GPs are then forced to wait 14 hours in accident and emergency. It is really holding people back. I raised the recent case of Patricia Anderson, who I visited. Her husband went to accident and emergency, was there for 14 hours and, after that, was deterred from going back there. He was looking for a GP and was going into the system but, sadly, he has now passed away. The deterrent for him was the fact the wait in Beaumont's accident and emergency was too long. The announcement yesterday is welcome but we need to make it a reality, deliver it, get in there and do, with a Covid-level response, what the Government has done in the past. People in this House mentioned the ambulance service. I brought some of the members of the Marino branch of the Order of Malta into the Gallery on the previous occasion. They are hard-working men and women volunteering their time, and there is also the National Ambulance Service, who bring an emergency patient to accident and emergency. Until that patient is brought through the systems of the hospital, the ambulance team is waiting there and the ambulance is lying idle. In other countries, they have adopted a system where, while that team is admitting a patient, the ambulance can be used to go to another emergency. I would love that to be looked at. Early access to GPs prevents hospital admissions, as I mentioned, and reduces the pressure on accident and emergency departments, such as at Beaumont, but the continuity of care and personal touch of a GP improves the outcome for those with chronic illnesses. We are not opposing, and I welcome, the increase in GP training places and retention measures, but these incentives for practices are underserving a fast-growing industry. The expansion of access to general practitioners is one of the most effective reforms we can deliver as a Government. I urge the Government to, as I said, have a Covid-level response and bring this in now because the people of north Dublin and Ireland as a whole need this now.

I thank the Social Democrats for this very worthwhile motion. I also thank the Government for the large amount of funding that was provided for services in Kerry, including an ambulance depot for Cahersiveen, which is much needed. People there struggled in the past to get an ambulance. University Hospital Kerry received quite a lot of money to increase beds and services there. I very much welcome a minor injury unit for Killarney, where the population sometimes doubles and trebles in the summertime. The mind boggles at the amount of money for its design - over €800,000. What will it cost before it is finished? Nevertheless, we want to get it finished and we need it very badly. The story about GPs in Kerry is no different from that across the rest of the country. Killarney’s population has increased and it is desperately hard for new families and others who come to the area to find a doctor to care for them. We need more doctors there. In rural areas, it is not possible to have GPs in the way we used to. They are not provided with enough funding to operate surgeries of their own, to have secretaries of their own or to have their own people running their practices. It is just not happening. The only chance that doctors get is to join an existing group of doctors, and that only happens in the very big urban areas, which means rural areas are left without a GP, especially at night-time. SouthDoc does great work, but Kerry is a massive area. Faraway places like Lauragh and Eskadawer, which is west of Lauragh and only a mile from Ardgroom, are 50 miles from Killarney. Invariably, people there cannot get a GP or a SouthDoc doctor cannot get to them, so all they can do is ring for an ambulance to be taken all the way to University Hospital Kerry, which is in Tralee. We need to see what can be done to bring the GPs nearer to the people, because people, including children, get sick at night. I remember on a Friday being told the story that my granddaughter had stopped breathing. The family failed to get a GP and an ambulance landed an hour and a half later. It was very worrying. The child is all right and grand now. It is very worrying for a first-time parent to see this happening and to have to wait for so long. These are the kinds of things we must avoid. If vulnerable people, especially the elderly, are so far from a doctor when something goes wrong, the only option I see for them is to be taken to the university hospital in Tralee. They may not need that. I am pleading with the Government to look into this because in the bad times when the country had very little, Kilgarvan had a doctor’s surgery. The doctor lived there. It was the same all over, including in Kenmare, Sneem, Lauragh and other such rural places. The GPs worked all hours, day and night, and did great work. We need them back again. The country had nothing at the time but it had doctors.

I thank our colleagues in the Social Democrats for raising the matter of expanding access to general practitioners. The Government acknowledges that there are issues regarding access to GP services in some areas, including certain rural and underserved areas. GP availability is limited and GMS GP vacancies have been difficult to fill. Others have spoken about this today. To improve access to GP services, we need to increase the number of GPs practising across the country, improve the support provided to GP practices and incentivise more GPs to practise in areas where service provision is most challenging. There are challenges and we acknowledge that today. We are aware that there is huge pressure on general practices. Our population is ageing and growing. In recent years, we have expanded free GP care and introduced new services, such as the chronic disease management programme. All this increases demand on general practice and we need to increase our GP workforce to ensure we can meet the need for GP care in the future. It is important to note that the Government’s expansion of eligibility for free GP care means 190,000 more people have access to the service today than before the expansion to six- and seven-year-olds and those earning no more than a medium income. We believe many more are eligible and can apply. We have run a publicity campaign to encourage them and we are looking at other ways to improve uptake. However, the number availing of free GP care is increasing. In line with this and as set out in Sláintecare, we need to expand our GP capacity to facilitate the additional demand on GPs and their teams. It is important to compliment them. We all know how hard they work. We need to consider this area and the demand the expansion of eligibility is creating. The Government has made significant efforts to increase capacity in general practice to improve patient access and has undertaken measures that address most of the points raised in the motion today. Investment in general practice has been significantly increased since 2019. This investment has provided for increased payments to GPs, new supports for practices and new services for GMS patients. Other GP services, such as the free contraception scheme, have also been established for patients regardless of GMS eligibility. The number of new entrants to GP training places is to increase to 400 from this year. This is almost double the number of new places available in 2019. The total number in training to become GPs has increased by more than 60% over the same period and will continue to increase over the coming years. Despite the increase, however, there are challenges. Trained GPs are also being recruited from abroad under a joint HSE and Irish College of General Practitioners international recruitment programme. The recruited GPs are placed in practices in rural areas and work in general practice while completing the programme, providing an immediate increase in service provision for those in that area. Under the GMS scheme, supports for practice staff have been significantly improved. Practice staff subsidies have increased and new supports for additional staff were provided under the 2023 GP agreement. Supports for eligible rural practices were increased and new supports were introduced for practices in urban areas of social deprivation. Supports are also provided for maternity leave and locum sourcing. A strategic review of general practice is due to be completed soon. The review is examining a wide range of issues affecting general practice, focusing on five important themes. We hope to have it quite soon. The five important themes are GP training, GP capacity, ehealth, out-of-hours reform, and the support model for general practice. The issues being examined reflect many of those raised in this motion. We can see the challenges. I totally understand what the Deputies have spoken about today and can see where their concerns are. We are examining the potential provision of HSE-employed GPs, as raised in the motion. When completed, the review will report on its findings and set out recommendations to provide for a more sustainable general practice. The findings of the review will help to determine what is needed from our next GP contract, to the benefit of both GPs and patients. Progress has also been made in other areas referred to in the motion, including in respect of primary care centres, which are essential to expanding healthcare provision in our communities. They are really important. We are looking at them all around the country. They are purpose-designed buildings that provide a single location for primary care services, including GP services. There are 180 centres open nationally, with 51 new centres having opened since 2020. The Government has committed to speeding up the delivery of more primary care centres. Many TDs spoke about primary care centres and the excellent work they do. Seven centres are currently under construction and 23 more are at planning stage. Therefore, there are many more to come. Funding has been provided to expand the GP chronic disease management programme to include additional conditions, including chronic kidney disease. Work is currently ongoing to provide for this expansion. However, further expansions of the programme would require careful clinical consideration and consultation with GPs and stakeholders to ensure any expansion can be rolled out effectively. This involves all of us working together. Work is also under way to develop a comprehensive women’s health programme in general practice in line with what is in the programme for Government. That is our commitment. With regard to general practice nurses, while practice nurses are employed directly by GPs and are not employed by the HSE, the HSE, as mentioned, does provide significant financial support towards their employment. The HSE also supports general practice nurses with continuing professional development by providing access to its online training platform, HSeLanD; centres for nursing and midwifery education; and library services. There is therefore a lot of other work being done as well. While 160 postgraduate education places are available in the student public health nursing programme, these places are filled based on the number of public health nurse vacancies and predicted vacancies that exist each year, and to date there has been no need to increase the number of places available on this basis. However, the higher education institutes concerned have agreed to increase the number of training places in 2026 if there is an increase in demand. To speak to some of the other matters referred to in the motion, with regard to universal primary and GP care, the Department of Health is reviewing the current eligibility framework to see how existing eligibility arrangements for health services align with patients' needs. The outputs of this work will feed into a broader multi-annual strategic review programme which will contribute to the development of evidence-based policy options for a future eligibility framework to support the move towards universal health coverage. The common conditions service, CCS, developed to enable community pharmacists in Ireland to provide advice and treat eight common conditions, is a private service delivered in person in registered pharmacies. The CCS is accessible to all patients regardless of GMS eligibility. As the CCS is a private service rather than a State-funded service, a consultation fee determined by the individual pharmacy does apply. In relation to the amendment tabled by Deputy Sherlock, I recall the remarks made by the Minister of State, Deputy O'Donnell, earlier in this debate. We are, of course, committed to the equitable provision of health services across the State. That commitment extends to all health services. For the reasons set out by the Minister of State, Deputy O'Donnell, the Government will oppose Deputy Sherlock's amendment. The Government has undertaken measures that already address many of the issues referred to in the motion. Accordingly, the motion is not opposed. I thank all my colleagues again for raising for discussion the important issue of access to GP care. Around the country we see the valuable work of our GPs and their teams. Within our own clinics we see the challenges, but with the review and all of us working together I am sure we will get as much done as possible, and as soon as possible, to address this.

I thank my colleague Deputy Rice for bringing this motion forward. It is a really important motion and is core to the Social Democrats. Why we are here and what we are about is ensuring that people have access to universal public healthcare as a human right and as a public service, regardless of where they are from and regardless of their income, that they have access to that most basic and fundamental need. Is ceart daonna í an tsláinte. Ba chóir go mbeadh rochtain ar sheirbhísí ardchaighdeáin phoiblí, an tsláinte san áireamh, ag gach duine. Caithfidh an iomarca daoine íoc go príobháideach as cóireáil, áfach. Unfortunately, too many people have to pay to access healthcare in this country. In my constituency, in areas like Ballymun and Finglas, which are some of the most deprived areas in the country, they do not have access to GP care, in particular in the area of Finglas west and south, which, as I said, has some of the highest levels of deprivation and poverty in this State, with a population of upwards of 20,000 and not one GP. GP Care For All has been trying to set up there. We are still waiting on support from the HSE and the Minister on that, and I hope the Minister of State, Deputy Murnane O'Connor, will come back on that. In other parts of the constituency, in Whitehall and Beaumont, we have an ageing population with complex care needs and, again, inadequate access to GP care. The workload for GPs is higher in disadvantaged communities, with patients presenting with more complex needs and developing chronic diseases much younger, yet our public health system does not reflect that. We need the changes put forward today in that regard. In 2019, the them Minister for Health, Simon Harris, committed to extend free GP care to children under 12. "We are extending free GP care to children under 12 years but on a phased and careful basis," he said. That was seven years ago. There is still no sign of it. Most people's understanding of a phased introduction is a year or two, not seven years. Contrast that with the way in which Fianna Fáil and Fine Gael have rammed through billions in VAT cuts to developers overnight. Fianna Fáil and Fine Gael do not wait around to remove rent controls, which will push thousands of renters into poverty, but when it comes to delivering public healthcare that would give real help to working families, they delay year after year. I will give a sense of that cost of GP care for families. I have a six-, a ten- and a 12-year-old. Before Christmas, my ten-year-old son had bad asthma. We had to go to the doctor a few times. My 12-year-old got a virus around the same time. Between doctors' visits, prescriptions, the multiple bottles of Calpol and Nurofen that parents know well, it cost me upwards of €350 within two weeks. Most families cannot afford that. We need genuine public, affordable healthcare.

When the former joint leader of my party Róisín Shortall founded the cross-party initiative that resulted in the Sláintecare report, there was a real sense that the ambition that people hope for but rarely see in the political system, a real effort to deliver a transformative change in healthcare, would be founded on enhanced State capacity and international best practice. While delivering such change might involve shifting timelines, one thing we should never shift is that ambition, which is why the Government's approach to implementing Sláintecare has been so disappointing. There is no sense of ambition in this Government in any area as it continues to rely on models which prioritise eligibility rather than rights and which fail to deliver the change needed in our healthcare system. The plans to introduce free universal GP care seem to have disappeared. This is in spite of it being identified as a core target within five years of the Sláintecare implementation phase. That means we should have had free universal GP care for every person in this country by 2022, four years ago. It is now 2026, and it is not even in the programme for Government. This means that we remain total outliers in a European context, where GP visits are mostly free or cost less than €10. A local GP noted to me this week that the current GP contract was developed in 1972. Since then, while remuneration rates for GP services have adjusted, the terms of service have not, with some areas of care - for example, antenatal care - being deprioritised financially versus others. We need an updated contract that aligns with modern clinical best practice. It is important to acknowledge that we train many more GPs than we did previously, and I welcome the work done in workforce planning. A publicly driven system would also allow for the development of a national locum bank, which would improve working conditions for GPs, ensuring they can take their leave entitlements, including long-term sick leave. The current environment, in which GPs deliver services through small isolated organisations, means the loss of a GP, even temporarily, can have huge effects on the delivery of care locally. I thank my colleague Deputy Pádraig Rice for bringing this motion to the House. I urge the Government to support it.

I thank Deputies from across the House for their support for the motion. GP services need more than a quick fix; they need an overhaul. This morning's debate makes that clear. I also thank those we engaged with on this motion: Deep End Ireland, the IMO, the Irish General Practice Nurses Educational Association and Doctors for Universal Healthcare, all of whom we met to discuss these proposals. I also thank the Rural, Island and Dispensing Doctors and the Irish College of GPs, whose research has informed the plan we put before the Dáil today. I also thank my own staff, Jake and Juliet, and the staff in the Social Democrats for their support. I want to respond to some of the comments made by the Minister of State, Deputy O'Donnell. He said the Government will not oppose this motion. That is welcome, but will the Government do it? Will it implement the 20 points we have set out in detail, and will it do so straight away? What we have in the Government, in particular from Fine Gael, is failed commitment after failed commitment. Fine Gael has now been in government for 15 years. That is almost my entire adult life. Back in 2016 it promised to roll out free GP care for children. We still do not have that and we are still left waiting. I therefore do not trust that the Government will do this, despite not opposing this motion. I urge the Government to get on with this and roll it out, fulfil the new programme for Government commitment for under-12s immediately and then set out a plan for universal healthcare for everybody by 2030. Sláintecare was mentioned, but the Government is not implementing it. The report was published nine years ago. We were meant to have free GP care by year five. Trust is broken, and it is up to the Government now to restore that, to get back on track and to deliver Sláintecare for the people. The deprivation grant was mentioned. We are calling for something different. It is not a one-off grant. We are calling for a change in the system, a weighted capitation, because we know the current system is not working. The new concentrated grant is not even being provided to some of the core GP services like GP Care For All, which did not receive the grant in the latest round. While the chronic disease management programme expansion is welcome, it needs to go further. We would like to see epilepsy included there. We would like to see severe and enduring mental health difficulties included. It needs to go further and faster. The Minister of State fails to recognise the real crisis in GP services. People are waiting weeks to get access to services and paying huge amounts out of pocket. There is constant mention of the GP review. That is now seven years old. We are waiting seven years for that and still the Minister of State comes in today and says we will get the review soon. Why does everything this Government does take so long? The common conditions services provided by pharmacists was also mentioned. The Minister of State said that is accessible to everybody. That is clearly not the case. You have to pay €30 or €35 to access that service even if you have a medical card. The most basic thing the Minister of State could do is remove that charge to make it free for everybody because at the moment not even medical card patients can access that new service. That ultimately needs to change. There is also mention of the primary care centres. Roll out of primary care centres has been so slow with just six due to open this year. The C and AG estimates it will take another 13 years to deliver the primary care centres listed for delivery in 2012. That is a shocking rate of delivery and it really needs to speed up. I also address some comments made by Deputy Tóibín from Aontú, which seems to be the first party in the Dáil to depart from Sláintecare. That is notable. He should also read the report from the Department of Health, which says that while uptake increases when you provide free GP care that will level off. I also wonder whether Deputy Tóibín is happy for half the population to continue paying huge sums of money out of pocket just to see a GP. It is up to €100 to see a GP. I wonder if the Aontú leader is happy with that. I ask him if he is on the side of the private insurance companies as opposed to ordinary people. What we have heard in this debate and from people across the country is that they want better access to GP services. They want the Minister of State to remove the cost barrier. They want her to make it free as promised, starting this year with under 12s and for the entire population by 2030. They do not want to wait weeks to access a service. We should increase capacity and the number of GPs. We have set out a detailed plan on how the Government can do that, and we urge it to implement this plan in full starting today.

In accordance with Standing Order 85(2), the division is deferred until the weekly division time this evening.