Dr. Brendan O'Shea:

We are very glad the committee is exercised about this. Again, we would look to other, better performing systems. Certainly, there is a need for a GP, one or two practice nurses and at least one full-time administrator. There needs to be quick and easy access to a psychologist. In Ireland, most practices include two to four GPs and they are very short of practice nurses. That is a priority. If one had a practice with two to four GPs and a psychologist split between two or three such practices, that would be very helpful. Dieticians are, arguably, further down the scale. Physiotherapy is particularly important, especially when one is looking after the care of patients with chronic diseases. As doctors, we are sometimes quite funny. If a diabetic patient comes to us, we look in particular at the diabetic things. We ask about HbA1C, if blood pressure is well controlled and whether the patient is taking aspirin or ACE inhibitors. A lot of the time, they have come back from hospital and are not on these things. What we forget to ask the patient is how he or she is feeling and what are his or her problems. We know these patients have a relatively high level of depression and quite a lot of pain. When we actually ask the patient, these are the issues. It is a curious feature of the current primary care team, as it is set up, that there is no input from the community psychiatric nurse. Those nurses are not part of our team, which is incredible.

The quick wins would be to increase practice nursing capacity immediately and to follow that up in short order with the allied disciplines. The big thing, as Dr. Mark Murphy will elaborate, is that this must be measured by automated, real-time electronic medical records. The good news is that we have those in general practice. They do not have them in hospitals. We can provide staggering data that will provide one with a very clear idea as to whether whatever one inputs next is working. One will know within six months.