Dr. Brendan O'Shea:

What we are looking at here is whether one size fits all or if there is one right answer. From looking at systems internationally, we understand that there are several right answers but unfortunately we have got a really bad answer in place at the moment. Different ratios can be used. We referred to the Veterans' Administration model where there is one GP to two practice nurses and an administrator as the core engine. Other systems have a 1:1 ratio. We have done several studies on Irish chronic disease management. We currently have a system where doctors are inappropriately involved at a lower level of complexity, holding the fort and metaphorically putting on Band-Aids. In fact, however, quite a lot of work could be handled effectively by more practice nurses' in-put.

We can look at the big picture figures in terms of how many doctors and GPs our system needs. From OECD data, we know that the Irish figures are shockingly low. Recently published figures are in the order of 35 up to about 57 GPs per 100,000 population. In Canada, the figure is closer to 80, 90 or even exceeds 100, so we are very short of GPs here.

Our college can switch on GP training if the process is supported in good faith by the legislature and the HSE. We can switch that on and we have increased it in the last several years. We will only do so if we are confident that our young graduates can enter into a system that will take them up and provide them with a contract that satisfies their professional ambitions and provides them with fair pay for fair work. We are competing on a global level with the economies of the UK, Australia and Canada where our graduates are highly prized.