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.

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