There are many commitments in the programme for Government to enhancing and implementing greater access to primary care services. At the centre of any primary care system is having enough general practitioners, GPs, in urban and rural areas. We all agree that the life of GPs is not an easy one. They spend long hours in surgery and in communities listening to, meeting and treating people of all ages at all times of the week. The Health Service Executive, HSE, planning office estimates that since the introduction of the GP visit card for children younger than six years, demand for GP consultations in this population will have increased by 65% in 2017 and by a further 42% by 2022.

This is also having an impact on patients' access to GPs. In some urban areas there are two to three-day waiting lists to see a GP, but the irony is that in many rural areas it is becoming more and more difficult to fill vacancies where a GP retires or moves to another location. The life of rural GPs has extra challenges because they are on call 24-7, living in the communities they serve.

The financial emergency measures in the public interest, FEMPI, cuts had a considerable impact on general practice and general practitioners. Allowances were cut by up to 38%. It is having a significant continuing impact on GP morale and on retaining people to work in general practice, which is resulting in GP shortages. According to the Irish College of General Practitioners, ICGP, there will be shortages in the order of 1,000 GPs in the next ten years and 36% of our current cohort of general practitioners are over the age of 55. The Irish Medical Organisation, IMO, which we met here last week, says there are 666 GPs over the age of 60 who will be retiring over the next five to seven years, of whom 244 will retire over the next two years.

Those statistics are real people, real lives, and people making choices about their own lives. They also represent a very vital community service that may be withdrawn or restricted. The Minister for Health and the Government are meeting this impending crisis in primary care with their heads stuck in the sand. Where are we at and why is the Government continuing to delay discussions on FEMPI reversal for GPs when there has been progress across all other cohorts? Why is the Government not responding to the crisis of GP morale and recruitment? Will the Tánaiste confirm that the concerns of the GPs about the FEMPI cuts will be addressed and that there is a pathway for them to see a future, not just for themselves but for their communities?

I accept that there is a need for continuing dialogue and discussion between the Minister for Health and GPs. The Government's focus is on shifting the emphasis towards primary care. That is why we are spending very significant capital resources on building new primary care facilities and improving facilities for GPs. That has happened in towns around the country and in the cities as well. In respect of the added pressures on GPs, our focus has been primarily on trying to deliver better patient outcomes so that parents can afford to bring their children to the GP at an early stage of sickness to avoid more complex and more expensive medical treatment being required. We continue to be committed to that policy. Affordable primary health care provision through a GP-led service is a major pillar of healthcare policy for this Government. I believe most people in this House support that. The financial arrangements to unwind the impact of FEMPI on GPs is a matter for negotiation between GP representatives, the Minister for Health and the Minister for Finance. I am not going to make commitments while that negotiation continues.

The Tánaiste speaks about dialogue but there is no dialogue. The discussions around FEMPI have been long-fingered. The National Association of General Practitioners, NAGP, which represents many GPs, is not even involved in them. Research and surveys are available to show that up to 70% of GPs are no longer in a position to take new patients because of the pressure on their practice, yet the Tánaiste speaks about wanting affordable GP access. It is not possible to have affordable GP access when there are not enough GPs or when GPs are saying they do not have the resources to take on any more patients. We spend only 3.5% of our health budget on general practice in contrast with over 8% spent by the National Health Service, NHS. In Australia, which is actively recruiting GPs from this country because of their training and skills, that figure is even higher. The Tánaiste speaks about dialogue and says it is a matter for the Ministers for Finance and for Health, but the Minister for Health is asleep on watch on this one. Seven out of ten GPs say they can take no more patients, and along with the figures for impending retirements, people walking away from the service, and incredibly committed health professionals saying they have had enough, communities are being left without a service. The Tánaiste should stop talking about discussions and start discussing and wake up to the reality of this crisis.

That discussion is under way. The Government is committed to engaging with the representatives of general practitioners on the development of a package of measures and reforms to modernise the 1999 General Medical Services, GMS, contract. Our goal is to develop a contractual framework that has a population health focus, providing in particular for health promotion, disease prevention and for the structured care of chronic conditions. This will enable general practitioners to better meet the needs of patients and will also promote general practice as a viable and rewarding career for existing doctors and future graduates.

Agreement on the delivery of the service improvements and contractual reform has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis. The Department and the HSE met the IMO GP committee in early May, with the State's side setting out the mandate agreed by the Government under the consultations conducted and the package of measures to be agreed. The conversation the Deputy talks about is under way.

It is not. It has not met since May.

It is not getting anywhere. There are people leaving in droves.

These negotiations are never easy or straightforward. They will need to conclude to ensure that we have sufficient numbers of people coming into general practice in the years ahead to fulfil the policy we are pursuing. That is what the Minister for Health is focused on.