I raise the problem people around the State have in accessing a GP or getting a GP to take them on. It is even more difficult for people who do not have a medical card. It is a huge problem. There is a shortage of locum doctors, which leads to problems for some GPs trying to take holidays or leave. The emergency departments of hospitals are clogged up with people who should be seen in a community care or primary care setting. Some go to emergency departments either because they cannot get a GP appointment or do not have a medical card and cannot afford a GP visit.

A recent Economic and Social Research, ESRI, report outlined that we need between 943 and 1,211 to cope with demand. That is just to stand still, not to improve the ratio of GPs per head of population. We know from several sources that the number of GPs per head of population is way too low and is completely out of sync with our European neighbours and other developed countries.

The Irish College of General Practitioners has stated that we have a huge deficit. It has identified several counties that have a chronic shortage, including County Laois. The Irish Medical Organisation, IMO, concurs and has highlighted this fact as well. The State has only 60% of the GPs per head of population that Germany and other EU states have. Some EU states are even more favourable than that. The IMO reckons one GP per 900 people is required to provide adequate community care. The World Health Organization says it is one per 1,000 population.

In County Laois, the ratio is, on average, one GP per 1,600 population. Only 35 GPs out of 67 in the county take medical cards. At least 700 GPs are to retire between the years 2023 and 2026. There are not enough new GPs in training and in many cases, when they qualify they are faced with a choice of trying to establish a general practice or emigrating. Some emigrate because of the cost of trying to establish a practice, pay for premises, hire equipment, hire staff, etc., and the long hours. We have a chronic shortage due to the lack of forward planning by all Governments over the previous 20 years. Solutions are needed now.

We need a major ramp-up of directly employed, salaried GPs working in general practice. Last week, the Tánaiste said here he is in favour of this as well. Many of those trained GPs would be more likely to remain if they could work in a 35 to 40 hour week job, particularly a lot of women who are coming into it - more women are coming in and that is welcome - because, unfortunately, they tend to have more home and caring responsibilities. As a society, we have more work to do in that area. The number of training places needs to be increased substantially. When young GPs qualify, the HSE needs to actively recruit them and offer them permanent positions.

I thank the Deputy for raising the issue of primary care and GP provision. Undoubtedly, in rural Ireland in particular and in some urban areas, over recent years there have been challenges accessing a GP and getting a GP. On the other hand, there have also been significant developments and growth, particularly in terms of the number of places at third level. That has increased very significantly over the last two to three years. The work done by the then Minister, Stephen Donnelly, with the Tánaiste when he was Minister for higher education resulted in additional places in our colleges. It will take some time for those places to come through. We also secured additional post-graduate education places more generally. That is important.

We have 179 primary care centres in the country now, which is very significant, and 50 new ones have opened since 2020. On chronic disease, 95% of GPs are now signed up to the chronic disease management programme; there were more than 645,000 patient reviews by GPs in 2024; and 92% of patients with chronic diseases are now fully managed routinely in primary care and not attending hospital for managing their condition.

The number of new entrant GP training places has increased significantly in recent years and is up 350 for 2024. College and training places continue to grow and an additional 662 student places have been provided in the higher education sector on health-related courses overall this academic year, which include nursing and midwifery.

The growth is there within the third level colleges but the quality and nature of the work of GPs is changing. That work on chronic disease is essential for outcomes and for the community enhanced care programme. A lot of GPs speak very highly of its impact. Overall, our figures as a country on life expectancy are improving because of the stronger role of primary and community based care and the management of chronic disease, along with public health measures and better quality of work within acute hospital services. Our life expectancy is above 82 years of age. Our mortality fell by 11% over the decade 2014 to 2022. The mortality rate for all circulatory system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37%, respectively. There is another perspective to our health narrative which rarely gets articulated.

I thank the Taoiseach for his reply. I acknowledge there are more training places but, as he correctly pointed out, it will take time for them to work through. The one thing we need to do better on is the retention of those who are coming out of courses. I have outlined to the Taoiseach the idea of directly employing GPs, which the Tánaiste said he is in favour of.

It was a key part of Sláintecare. We should remember it was agreed in the Oireachtas nearly eight years ago. Primary care and community care are absolutely central to the implementation of Sláintecare and are the cornerstone of a public health system. We must try to do better on that if we are to improve things. There needs to be a big shift of healthcare from hospitals to primary care settings. Our hospital wards are overcrowded and our emergency departments are bulging. The best we can hope for, with the figures coming through at the moment, is to stand still. Standing still is not good enough and we have to do better. Life expectancy is becoming longer and we will have a lot more older people, including a lot more over-80s. We need to work better at this and try to have more directly employed GPs to supplement ordinary general practice ones in the State.

The new programme in Galway will be specifically focused on rural GP medicine. A huge investment is going into primary care and this area.

A primary care centre for Portlaoise?

Practices in receipt of the rural supports receive the maximum rate of practice staff subsidies, significantly reducing possible staff costs for smaller practices. They also receive the maximum rate of locum support for leave-taking. A new locum support initiative commenced in May, providing GPs in receipt of rural practice supports with access to a streamlined locum-sourcing service. The annual intake to the GP training scheme increased by approximately 80% from 2019 to 2024, with 350 new entrant training places made available from 2024. Three hundred and forty-six new entrants commenced training last year, representing a 21% increase on the previous year’s intake, 286. We will continue to build on that. Recruitment of GPs from abroad commenced in 2023 under a joint HSE-ICGP international medical graduate rural GP programme. One hundred and eighteen of those GPs are currently in practice and an additional 18 have completed the two-year course.