Dr. Ronan Fawsitt:

Deputy Hildegarde Naughten asked for evidence. While I am not an evidence person, I know the acute medicine programme Professor Courtney started in Carlow-Kilkenny reduced average length of stay in the hospital by 1.6 days within five years. That is the equivalent of generating 750 beds in the system and this has been documented.

As regards the community intervention teams, CITs, these are music to my ears. General practitioners need to be involved in the community, providing more services, and community intervention teams are an ideal way of doing so. The process is currently nurse driven. I would like it to be led by general practitioners but this requires GP-led primary care. In fairness, the Ireland east hospital group is looking at a process in Navan under which general practitioners would visit patients' homes as part of the community intervention team, put up the intravenous drips and monitor the patient with pneumonia over a weekend or whatever. The GP would do the extra visits.

As a general practitioner, I may see 40 people per day. Yesterday, for example, I saw 46 people face to face, including two home visits and two visits to nursing homes. If I receive a call in the middle of the day informing me that Johnny is very sick, I cannot make a home visit, even if his house is just down the street, because I do not have the capacity to be in two places at one time. However, if a general practitioner led CIT service was available and I was aware that Johnny had chronic obstructive pulmonary disease, CPOD, and needed IV antibiotics, oxygen and so forth, I could call the CIT service because I would know the colleague in the service would be a doctor rather than a nurse. While a nurse-led process is sometimes fine, in cases where clinical judgment is required, general practitioners must be involved. This is where GP led primary care can drive change.

The funding must follow the patient. The previous Minister often spoke of money following the patient. The money should follow the patient through the community intervention team process because it makes sense. General practitioners are trained and are like powerful thoroughbred horses. However, we do a great deal of plough-sharing when we could do much more if we had more resources. We want to do more and community intervention teams are an example of shifting care into the community to avoid people ending up in Professor Courtney's hospital or on trolleys in Beaumont or Our Lady of Lourdes hospitals. We must keep frail elderly people out of hospital using new care pathways. However, new care pathways cannot be agreed if there is no contact. I am taken by Deputy Harty's comment that he does not have a pathway for discussing clinical issues with his colleagues in Ennis, Limerick or Clare. It is for this reason that we need this type of process for engagement.

Deputy Naughten asked what evidence is available on our pathway in respect of admissions. We opened an acute surgical assessment unit, ASU, two years ago. The liaison committee discussed this issue in great detail over a number of years and we were pushing for such a unit. Within one year, the number of admissions for acute surgery declined from 4,500 to 2,500 because a senior decision maker in the community, namely, the general practitioner, now refers directly to a senior decision maker in the hospital, namely, the surgeon, and the patient is seen within one hour. If, for example, a patient has a problem with his or her appendix, he or she is seen by the surgeon and either admitted, operated and sent home or, where the case is not acute, he or she will be seen and sent home on the day. This process reduced the number of admissions by 2,000 in one year. It creates the efficiencies that would generate funding to drive the process of extending other services into primary care. If we make funding savings through this process, they should be reinvested in primary care to drive another project or to scale a project. If, for example, we have a successful community intervention team project, it should scale to Deputy Harty's patients as well.