Michael Harty (Clare, Independent) | Oireachtas source

I thank the representatives from Deep End Ireland for attending. I am a GP for a deprived rural area as opposed to a deprived urban area. I understand exactly what the witnesses are saying. I have some points which might help us come to a conclusion about how we can improve our health service. The inverse care law is well-known. It did not just appear yesterday. Tudor Hart was mentioned as an iconic figure in the NHS in general practice, and he has spoken about the inverse care law for many years. It states that the people who need the care most have the least access to it. We are still trying to reverse the position.

We have a huge problem recruiting general practitioners in Ireland. We are educating fantastic GPs but, unfortunately, we are not able to retain them. Retention and recruitment of GPs is essential to reversing the inverse care law. Our contract is a big impediment because it is very fixed and inflexible. That is the first issue to be addressed. We need also to recruit practice nurses and staff to deal with all other community services. Perhaps a practice needs a nurse before it needs a second, third or fourth GP. My practice nurse sees 33% of the patients without any reference to me. That is a huge resource. How we go about recruiting and retaining staff is the key.

Primary care teams are a fantastic resource. Unfortunately, they are not staffed either. There is great difficulty in retaining staff. Instead of building 80 new primary care centres, we should fully staff 80 new primary care teams. Perhaps these primary care centres could be used for diagnostic services, as diagnostic and treatment centres. It is very difficult to attract GPs into primary care centres throughout the country. The barriers to joining such facilities can be great.

There is a backlog outside general practice. If a person is referred, there is a huge problem in getting services. Communication is a huge problem. Hospitals are not very good at information technology, IT. GPs are extremely advanced when it comes to IT. Communicating with hospitals is very difficult. We will hear more about the integration of primary and secondary care during our second session. It is an extremely important matter. It is vital that we discover how they managed to do that. I would like the witnesses' views on that and on the huge barriers that exist.

In the context of the inverse care law, information and education are key to preventing illness developing. That starts in schools and other educational facilities. That is a problem in deprived urban areas. There has to be a medical education programme in every school about smoking, drinking, unsafe behaviour and healthy lifestyles. This will not give a result tomorrow or the next day but it will do so in ten, 20 or 30 years' time.