Mr. Mark Murphy:

The Chairman might be aware that the ICGP pulled out of all these clinical care programmes. Some 40% of the population have a medical card. That is an acute care contract. I cannot manage chronic diseases. Patients would have to be charged. In effect, patients have multiple chronic illnesses, so we are faced with managing their acute exacerbations. Some 60% of the population have to pay for services. That is outside the contract. We need a new contract to specify and regulate how we can meaningfully manage chronic illnesses.

On the matter of chronic illnesses, we provided a narrative in our submission of a typical patient whom we called Mary Smith. Dr. Liam McGlynn, an academic GP, has shown us that 66% of patients over 50 have multi-morbidity. This patient has asthma, depression, arthritis, heart failure and ischemic heart disease. She is on 13 or 14 medications. There is psycho-social chaos going on in her life. How do we meaningfully manage those diseases? We can return to the clinical care programmes. It all well and good having a single disease focus on, say, the way we manage asthma. There is a diktat and this is what we do. However, that is not the reality on the ground. We manage all those conditions together.

The management of multi-morbidity has been cogently outlined in the evidence. One needs to resource GPs to enable them manage all of these conditions together. How that is done in the contract, through a weighted capitation for multi-morbidity and deprivation, can be addressed with those organisations, but the Government needs to resource us. There are also guidelines for managing all of those illnesses when they occur together. Multi-morbidity is a key concept. We would like to get back involved in those processes. We are core, not peripheral, to those clinical programmes.