I will move channel away from RTÉ for the time being to the issue of rural doctors and burnout. Dr. Fiona Kelly is one of the finest rural doctors in this country. She has been practising in the Beara Peninsula since 2009. She is dedicated to her job, is hardworking and almost always contactable outside working hours. She offers same-day appointments for anyone in need and still takes on new patients among those who move to the area because she realises that rural GPs are few and far between. She rarely gets a lunch break and never gets home when she should. Despite all this, she still loves her job.

I will reference social media posts Dr. Kelly put up last Friday while on a short holiday in Italy with her family following a tough year for them. This holiday would not have been possible had it not been for a retired GP contacting Dr. Kelly after hearing her discuss on "Prime Time" in 2021 the dire situation facing rural GPs in Ireland. This lovely and obliging GP who agreed to provide cover realised some weeks ago that her medical insurance and registration would run out at midnight on Thursday. She tried in vain to renew it for one more day, to cover Friday, but she was met with a resounding "No" and was told she would have to renew for a full year, which would cost her several thousand euro.

Dr. Fiona Kelly's frantic search in Italy for a single day's cover began. She directly contacted three other GPs to cover Friday but they are not renewing their registration. It seems to be the norm that older GPs are retiring and there is nobody to take on their practices. Dr. Kelly's practice manager contacted two locum companies and placed an advertisement on a GP forum. She also made several word-of-mouth inquiries but, alas, all their efforts were unsuccessful. The difficult decision was taken to close the practice on Friday. Dr. Kelly assures me, when I talked to her at her clinic in Castletownbere on Monday, that this decision was not taken lightly. She did everything in her power to secure a locum doctor for Friday but such doctors simply do not exist. Dr. Kelly received an email on Friday morning from the HSE primary care unit asking her to explain the closure. Dr. Kelly was in Italy receiving calls every 30 to 60 minutes from her excellent practice manager and front office team who were manning the phones and relaying Dr. Kelly's guidance to the many patients needing care in the absence of a GP.

Dr. Kelly has many solutions to the GP manpower crisis that Ireland is currently experiencing. However, nobody has ever asked the opinions of someone like her, who is in the thick of it. Ironically, it took just 30 minutes for a HSE official to contact Dr. Kelly regarding her closure. These were the same people who could do nothing for her days before.

The bottom line is that general practice is on its knees. The manpower situation has reached a crisis level. GPs are retiring in their droves and they are not being replaced quickly enough. This situation was predicted when Dr. Fiona Kelly was a student and absolutely nothing was done about it. GPs who are still working are facing burnout and nobody cares. Dr. Kelly experienced this at first hand on Friday. Officials are quick to pounce when things do not go smoothly but they have nothing positive to say about her 14 and a half years' service. To say that Dr. Kelly is disappointed is an understatement.

I thank the Deputy.

It is no wonder that newly qualified GPs are emigrating as soon as they qualify. It is no wonder rural areas are suffering. It is no wonder GPs are closing their lists to new patients. What is the Taoiseach's solution to this crisis?

I thank the Deputy for raising this important issue. I know Deputy Cairns raised it yesterday as well. I do not want to comment directly on Dr. Fiona Kelly or Castletownbere, but I will certainly make sure that somebody, either from my office or that of the Minister for Health, Deputy Stephen Donnelly, reaches out to her to hear what she has to say.

I do know something about general practice. I am a trained, qualified GP. I worked in the public health service for seven years, including three years in general practice. My dad was a GP. I grew up over the shop. It was a traditional, single-handed general practice. My mum was the practice nurse, manager, accountant and secretary. Patients came to the extension of our house. That is where patients were seen. For a very long time, my dad got up every single night to do house calls. Every single night the phone would go off at 2 a.m. or 3 a.m. and he would go out and do house calls. I remember how hard it was, even back then in the 1980s, to get a locum to fill in, for example, for a week’s holiday or even so he could attend my communion and confirmation. It was hard back then and the truth is that general practice has changed.

GPs of my age and younger GPs are not willing to work that way any more and they should not. They want to work in teams where there is cross-cover and where they can be guaranteed things like the holidays and breaks they deserve. That makes it harder, therefore, to maintain single-handed practices, whether this is in urban or rural areas. That is a real issue that we need to be honest about and face up to. Even where locums are available, they tend to want to go into group practices, where there are two or three other doctors who know where things are and how the building works, rather than going in on their own to a single-handed practice where there is nobody to guide them. That is the reality and is something we have to face. It will be very hard to get doctors to work in single-handed situations in the future. That is why it is important and necessary that we move towards primary care centres and group practices, notwithstanding the difficulties that creates when people will have to travel a little further, or a lot further in some cases, to see their GP.

However, some of what the Deputy said is misinformation. We have more GPs in Ireland than ever was the case before. Do not believe me; ask the Irish Medical Council, which is an independent body. It is not elected by or controlled by the Government. It will tell you that we have more doctors who are registered as GPs in Ireland than ever was the case before. The HSE has more contracts with individual GPs than ever was the case before. Yes, we need them, because we have a rising population and an ageing population. We will need more. We have trebled the number of GPs being trained every year to make sure that is the case. However, it is simply misinformation to say the kind of things that the Deputy said there-----

It is not.

-----which creates the impression that the number of GPs is going down. It is not. Is going up, and it has never been higher.

Maybe if the Taoiseach had listened to my speech, he would know that they were extracts from Dr. Fiona Kelly’s social media. That is what I read out. It did not come from me. I say that to start with.

Second, where are the GPs the Taoiseach is talking about? Obviously, the Taoiseach says that there might be more GPs, but we have a bigger population, too. That has to be taken into account. His answers today have given me no confidence whatsoever, which every rural doctor and the people of Castletownbere would have wanted. It is similar to the same old spin.

I have spoken to rural doctors and they have solutions. First, on keeping doctors with General Medical Services, GMS, contracts that state GPs have a 24-7 commitment to their patients, younger doctors are not willing to accept this commitment and responsibility. The contract needs to change. Second, the HSE must accept some responsibility for helping to secure locum cover for sick leave, annual leave and maternity leave. Third, GPs should have protected time off for annual leave, sick leave and maternity leave. Otherwise, burnout is inevitable among existing GPs. Fourth, we should cut the red tape and register doctor applicants from outside the EU in no more than one month. Up to now, the process the Taoiseach endorsed so much is a failure because it takes seven to 12 months to register. Fifth, we must allow some older GPs who do not want to retire fully and who want to cover a session or two a week to pay a very reduced rate of insurance registration.

I thank the Deputy.

If this were the case, the Castletownbere clinic would not have been forced to close last Friday. These are just a few solutions to a huge crisis. Will the Taoiseach work with the likes of Dr. Fiona Kelly throughout the country, or will he let such doctors burn out and close their doors?

We are working with doctors to deal with some of those issues. For example, just on 3 April, we published the terms of reference for a strategic review of general practice. That is the HSE and all stakeholders, including the Irish College of General Practitioners, ICGP, and the Irish Medical Organisation, IMO, working together to deal with some of the issues the Deputy mentioned. Yet, some of the issues are not as straightforward as the Deputy might make out. We have had some difficult experiences with registering foreign doctors in Ireland. You are asking for trouble by just saying that we should register somebody in a month, quite frankly. There are a few things we need to be very careful about. If we register somebody in a month, fast-track them or do it quickly and if they turn out not to be qualified or not to be the person they claim they are, the consequences will be catastrophic for patients. Therefore, the Deputy needs to think through some of the suggestions he is making.

In terms of what we are doing, we have increased the rural practice allowance by 10%. In the agreement we just made with GPs the other day in relation to the extension of the GP visit cards, we have made improvements to maternity and paternity leave arrangements. Under the 2019 agreement, an additional €210 million is allocated to general practice, which is a 40% increase.