Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and thank them for their presentations. We speak of primary care as the bulwark of delivery of health care in the future. To date, it has been under-resourced, understaffed and under-utilised in many cases. During the Celtic tiger era we placed much emphasis on the physical structures of primary care, namely, the buildings. Let us be under no illusion, not every GP in the country embraced primary care teams. There was quite an amount of resistance. That was and is a problem because some GPs were not willing to engage with the process.

I have always felt that we are missing a link in the primary care strategy and it relates to diagnostics. There are primary care teams in some areas and there are primary care centres in others. Ultimately, all diagnostics have to go to the acute hospitals, through a referral to a consultant. Is there a link that we should establish? Rather than obsess about primary care centres in every community, we should have primary care teams and more regionalised centres for diagnostics. GPs should also have the facility to refer directly to a centre that is a step above a primary care centre where there would be other specialties and resources, as opposed to always referring into the acute setting. Once the referral is made, access depends on what comes through the emergency department of the hospital. There can never be a streamlined approach of elective referrals, surgeries, etc. Almost everybody ends up going to hospital through the referral process.

On the inverse care law and the need for resources in deprived areas, I represent a constituency which is a microcosm of Ireland and which comprises the most affluent and the poorest areas in an urban setting. I can see in people the differences in quality of health and the impact lifestyle has on health. There is a huge problem with diabetes, smoking, alcohol and poor housing, which give rise the outcomes we all know - cancer, cardiac problems, stroke and life expectancy issues. We simply are not investing the requisite resources. We are also making no effort on the preventative side. We all know that if people smoke less and have a healthy diet, they will have a better chance of living longer. The people who most need to hear the preventive advertising campaigns are least likely to hear them. Do we need to target resources, through the primary care teams, school, educational programmes and local authorities on real preventive efforts, as opposed to ticking boxes for a national campaign, knowing that the people who most need to hear the message will probably not be listening? There is a huge weakness there.

On the issue of salaried GPs, we are aware of the impact of the inverse care law, namely, that where resources are most needed, they are not in place. As opposed to weighted deprivation payments, would having salaried GPs in a problem area help? Would that be possible?

I am not criticising; I am making an observation. There is resistance, however, and every profession likes to have professional integrity and professional protection and they do not like the lines of demarcation to be frayed away at the edges. Prescribing nurses, for example, is something that can be resisted by some GPs. Are we using nurse specialists, practice nurses and community pharmacists fully as a resource and should there be a lot more emphasis on nurse specialists and practice nurses in primary care settings and in primary care teams?

If we are to establish primary care teams, I would like to think that there would be a possibility for GPs to specialise in certain areas. For example, demographic profiling of certain areas will show if there is going to be an ageing profile over time, so GPs would specialise in geriatric care. Could we be more imaginative in using the resources of the GP, the primary care team, nurses and nurse specialists? I have rolled observations and questions into one.