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.

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