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.

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