I thank the Cathaoirleach for selecting this important Commencement matter and I thank the Minister of State for attending today. While I know he is not the Minister for Health, he does have a health portfolio and brief. I thank him for giving of his time in coming here. I know it is an exceptionally busy day in the Oireachtas.

My Commencement matter deals with the escalating GP shortages, with rural communities being hit the hardest. I took a look at the parliamentary questions put down in the other House over the last 12 months. The responses were continuously about a review mechanism and a review group. I have no doubt the Minister of State will tell me about these in a few moments. I want to hear a bit more. I want to hear when this review group will have completed its work because the various Deputies who continue to ask parliamentary questions on this matter are getting the same response. Surely time must be up, but I will deal with that in a minute.

The latest study carried out by the Irish College of General Practitioners, ICGP, analysed the distribution of GP practices across the country. The Minister of State will know I like figures, particularly those regarding local electoral areas, LEAs, which are represented by our city and county councillors. The study used the model of the LEAs of the city and county councillors for this research. The Minister of State will be familiar with it, or he should be. I am certainly happy to share a copy with him afterwards. The authors came up with an exercise based on this demographic mapping. This confirmed for once and for all what had already been confirmed by the ICGP. Indeed, it was recently reported on RTÉ's news feeds. This new ICGP data shows that the areas of pressure where GPs are needed most include the north west, with Donegal, north Mayo and Leitrim at the top of the scale, and the north-east Border areas of Cavan, Monaghan and north Louth. My colleagues in the Seanad who are from these areas will have great interest in and knowledge of what is going on there. These areas of pressure also include the mid-east commuter belt, especially parts of Kildare, portions of Meath and the north Dublin areas of Finglas and Coolock, the south-east LEAs of Kilkenny, Carlow and Wexford, and the mid-west regions of east Clare and east Limerick. The Minister of State will be very familiar with the last area I mentioned. Commuter belt areas are clearly under enormous strain and pressure. Their population growth and new development are outpacing the number of new GPs coming on stream.

As of today, there are 4,600 practising GPs in the country but this organisation's data estimates that there is a need for 6,000 GPs to provide coverage at this point in time. This shortfall stems from delays in developing primary care centres. It also has an impact on general practices, particularly in rural areas, where GP succession is a major challenge. It is not always a problem, but it is a challenge. Of course, people have relationships with their GPs. We tend to stay with our GP all our life. Someone told me that, if I was ever looking for a GP, I should make sure he or she is younger than myself so they can at least see me through to old age. Older patients relying on their GPs are also suffering and being left out. There is a challenge in terms of community care.

I will push on a few issues to demonstrate my understanding of the problem from having talked to GPs around the country over Easter to ascertain the difficulties. They tell me that the challenges include a retiring and ageing workforce, rising demand, recruitment and retention, the rural-urban imbalance, and the workload pressures on patients and those in the profession. With regard to the impact this is having on patients, some patients are arriving at surgeries and cannot get cover. Other challenges include the difficulties associated with registration, and rural discrepancies and disparities in different parts of the country. What I really want to hear about are the Government's proposals. I am driven by solutions so I want to hear about the solutions from the Minister of State. In wrapping up, I will say that it is important that we look at the strategic review the Minister initiated over a year ago. It must be well advanced. How is that going to progress?

I thank Senator Boyhan for raising this important issue. I am taking this matter on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill. The Government recognises the need for more GPs not only to meet current demand, but to meet the future needs of our growing and ageing population. A strong and sustainable general practice is essential to our health service. As Senator Boyhan has said, GPs are a vital component of our health system. They do great work.

For that reason, the programme for Government commits to increasing the number of practising GPs through a combination of increased training places and international recruitment, while several steps have already been taken in recent years to increase GP capacity.

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 increased by over €340 million under the 2019 and 2020 GP General Medical Services, GMS, agreements. The 2019 GP agreement provided for an enormous 50% increase in capitation payment rates for GPs and a 10% increase to rural practice supports. Improvements to GP maternity and paternity leave arrangements were also made and a support for practices in urban areas of deprivation was introduced. The 2023 GP agreement introduced a new grant for additional practice staff capacity and a support for staff maternity leave taking. It also provides a locum sourcing support for rural GMS practices; the Senator alluded to rural practices.

The annual intake of doctors into the GP training programme has been increased by approximately 80% from 2019 to 2024, with 215 new entrant training places made available in 2024 and again in 2025. The number of new entrant training places has been increased by a further 50, which brings it to 400 places this year in 2026. As a result, the number of GPs graduating has increased and will increase more in the next few years. Future increases in the number of GP training places will be kept under consideration. In addition, the recruitment of GPs from abroad commenced under the international medical graduate, IMG, rural GP programme in 2023. Under this programme, GPs work in general practice while undergoing two years of self-directed learning after which they can register under the medical council specialist register and take up a GMS contract themselves.

As of 2019, there were 111 doctors in practice under the IMG programme. Fifty-eight more have completed a two-year programme. The placement of IMG GPs in practices is targeted at rural areas and difficult to fill posts in various locations around the country. In addition to the ongoing work to increase GP numbers, a strategic review of general practice is currently under way. I anticipate the Senator will enquire when it be completed. The Department advised me that it will be completed this year. The review is led by the Department of Health with support from the HSE and input from stakeholders. It examines a range of important issues affecting general practice around capacity, training, out-of-hours services, ehealth and the need for further and revised supports for general practice. The potential for HSE-employed GPs as well as other possible measures to bring more GPs to underserved areas is also being examined. Continuing to train, increase GP numbers and recruit more GPs from abroad will see our GP workforce grow, while the work of the strategic review will provide the basis for the future sustainability of general practice.

Before I call the Senator, I welcome guests of the Ceann Comhairle, Deputy Verona Murphy, to the Gallery from Piercestown National School. They are most welcome to Seanad Éireann. I am sure the Ceann Comhairle told them that when they visit Seanad Éireann, part of the experience is that they have no homework for the rest of the week. I ask them to make sure if there is anyone giving them any homework that they write to me and I will sort it out.

I thank the Minister of State for his detailed response. Hopefully, the review will identify arrangements necessary to improve the current system of GPs. It is going on a long time. Clearly, Deputies will continue to ask parliamentary questions. We will continue to table Commencement matters. I thank the Minister of State and the Minister for her commitment to the review.

I thank the Irish College of General Practitioners for following the local authority electoral areas to do its research and give such qualitative responsive research. That has helped me today to do my work here, which is to advocate for these communities. I would also like to give a word of caution. GP shortages are putting rural patients at risk. That is an important call. I am saying that here and now on the record of this House. GPs are telling me and elderly people in our communities are saying that they feel they are risk. Many people are telling me that they cannot get a GP. They are arriving at doors in Limerick, Cork, Monaghan, Donegal and Dublin. They are being told, "Sorry, you can go a list, but I am not really interested" or "Are you a private patient? I might fit you in, but I have no more room for public patients." We have a two-tier health system. GPs are not being given the support they need. I look forward to, hopefully, the strong recommendations that will come out of the Minister's review, which is mandated to report to the Minister.

The Minister will consider it and has given the commitment to publish at some stage in the future, so I thank the Minister of State.

I join the Cathaoirleach in welcoming the group from Piercestown National School. It is great to see so many young budding politicians seeing the Seanad in operation.

I again thank Senator Boyhan for raising this important matter. As stated earlier, I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. The Government acknowledges there are existing pressures in general practice. The recent ESRI report on GP capacity shows that our ageing and growing population, which Senator Boyhan has referenced, along with the shift to provide greater care in community-based settings, will increase demand for general practice services in the coming years in all areas, with more GPs and general practice nurses required to meet this additional demand.

The report identifies the need for between 943 and 1,211 additional GPs and between 761 and 868 GP nurses by 2040. The number of new GP training places is to increase to 400 this year. We have nearly double the number of new entrant places available since 2020. In addition, trained GPs continue to be recruited from abroad and other international medical graduates and placed in practices in rural and underserved areas, providing an immediate increase in service provision for those areas where more GPs are most needed. When completed, the report and strategic review of general practice, as set out by the Minister, will provide for a more sustainable GP service into the future. The points the Senator has raised will be brought to the attention of the Minister for Health and the Department.