Dr. Pádraig McGarry:

I thank the Chairman for affording us the opportunity to speak to the committee today.

Despite its role at the heart of medical care and its presence in communities throughout Ireland, general practice is often neglected when it comes to health service planning. I work as a GP in Longford and, from first-hand experience, I can tell the committee that the under-resourcing of general practice in Ireland is one of the fundamental causes of its current inability to adequately meet patient demand. Population growth, shifts in population age distribution and increasing multi-morbidity in patients places greater pressures on general practice, while an ageing GP workforce and high-levels of GP emigration restrict the ability of general practice to cope with this increased workload.

In ten years' time, Ireland will likely have 60% more patients aged 65 years or older than is the case today - an increase of 20,000 in such patients every year for the next ten years. However, with 34% of GPs currently over 55 years of age and 17% of our newly qualified GPs working abroad, significant investment will be needed to meet future health care demands in general practice. The HSE has estimated that by 2025 an additional 1,380 GPs above projected levels may be required to maintain existing service provision, while an additional 2,055 may be required to provide universal care in general practice.

While attaining these increases in medical manpower may appear to be a daunting challenge, it is one that can be met. The solution can include: the agreement of a new fit-for-purpose contract for GPs that properly resources the work of doctors in communities; investment in evidence-based chronic disease management programmes; allowances for the employment of practice staff; supports that address the specific needs of practices and patients in rural and deprived areas; incentives for GPs to develop their practices; and swift access to diagnostic equipment for patients in general practice. All of this will result in the retention of newly-qualified and existing GPs, and a return of many who have left to practise overseas. This will create an environment where GPs want to work in the service.

I also want to briefly address some remarks that have been made in other meetings of the committee about the independent contractor model versus salaried GPs, and the role of other health professionals in general practice. On the first point, while there may be some merit in examining the role salaried GPs could play in some circumstances, the independent contractor model that currently exists in Ireland and most other developed health care systems broadly remains superior to other models in terms of its patient focus and value-for-money. GPs invest significantly in their practices and, once established, tend to remain rooted in their communities. This provides for a strong continuity of care experienced by patients and the lasting doctor-patient relationship, where a patient typically receives care from his or her specific GP, is associated with lower patient mortality and superior patient health outcomes.

This continuity of care may be threatened where GPs are salaried and, therefore, perhaps less rooted in their communities. The contractor model is to be distinguished from the corporate model, in which private firms invest in community health care for the purpose of extracting profit from the provision of services to patients. Such commercially-driven enterprises do not support the continuity of care in general practice that benefits patient welfare.

The role of other health professionals in the delivery of care is relevant to all categories of doctors. It must be borne in mind that different health professionals are educated and trained to perform different tasks. While there is scope for limited transfer in some areas of the health service, the shifting of significant aspects of doctors' work to the remit of other health professionals carries some negative consequences. In general practice, for example, non-physician health professionals often spend twice as long on consultations as GPs and use more health resources generally as a result of consultations.

I point out this research only to demonstrate the reductions in efficiency and cost increases that occur when health professionals move into areas for which they are not trained and thus unsuited. All health professionals' education and training is highly specialised and tailored to the performance of specific tasks. We are not interchangeable. We must focus on ensuring the employment of sufficient numbers of health professionals of all types to guarantee the best patient outcomes.

As Dr. Gilligan already mentioned, our statement focuses on capacity, staffing and the role of general practice. This is not to diminish the other aspects of our submission. For example, proper provision must be put in place for long-term and rehabilitative care. On "Morning Ireland" earlier, Professor Joseph Harbison highlighted this regarding rehabilitation beds for stroke patients. A new mental health strategy that puts mental health on a par with physical health and a detailed plan for its implementation must be put in place. A resourced and organised community health service and public health service must be provided, including expansion of public health capacity through a new fit for purpose contract. Appropriately developed capacity, staffing, and general practice are the foundations on which all other aspects of the health service are built, which is why we have placed so much importance on improving health care in these central areas.

I thank members for their attention. Dr. Gilligan, Mr. O’Dowd and I will be happy to address any questions they may wish to pose.