Dr. Emmet Kerin:

Chairperson, Deputies, Senators and colleagues in health care, we wish to thank the committee for inviting us here this morning to discuss general practice and its role in fixing our broken health system and the manpower crisis it now faces.

My name is Dr. Emmet Kerin and I am the President of the NAGP, which represents 1,920 of Ireland's 3,000 general practitioners, GPs. I am here with my colleague, Dr. Liam Glynn, who is the NAGP chair of communications. We are both full-time practising GPs in urban and rural practices, respectively. Our patients are directly affected on a daily basis by the issues we will discuss today. We strongly support the work of this committee and the Oireachtas Joint Committee on the Future of Healthcare committee in the development of a ten year plan for healthcare. The NAGP has also advocated for such a ten year plan.

We have an upside down health care system which is hospital-centric. Our hospitals are overwhelmed. To address this, we need a paradigm shift in health care, away from hospitals and towards GP-led primary care. GPs know their patients. They are the senior decision makers in the community and can lead team based health care which is person centred and population focused. GP-led teams are ideally placed to keep more patients well, cared for close to home and out of costly hospital care.

To achieve this, we need to support general practice. This means two things: First, we must provide proper funding for general practice similar to other OECD countries; and, second, we must provide enough GPs to lead and deliver the required primary care service for the population. Unfortunately, we have a manpower crisis of monumental proportions in general practice. Every year some 50% of our newly trained GPs emigrate. That figure is growing. We need 4,500 GPs by 2025 in order to provide safe, effective and efficient general practice. The challenge is stark.

Recruitment of GPs is a global issue but we are exporting our GPs. We are competing also with Canada and Australia where general practice is supported by adequate resources, access to diagnostics, with a better work life balance and career structure. We need a new GP contract which is fit for purpose and which will attract our young, highly trained GPs back to Ireland. This is critical if we are to facilitate the shift to a GP-led primary care service that is central to the future of healthcare. I am glad to say that the NAGP is actively engaged in this process.

We need special supports to attract GPs to work in urban deprived and rural settings. Here, the use of technology with virtual clinics and the networking of singlehanded rural practices is especially important. We need to support the pivotal role that practice nurses can play in addressing this issue. We need increased numbers of practice nurses with roles in chronic disease management. We would also welcome the addition of health care assistants, physician assistants and clinical pharmacists to work in general practice as part of the new clinical team. This team can provide services such as chronic disease management, residential care, minor surgery, end-of-life care and enhanced acute care in the community, especially for the frail and elderly. To build primary care we need to develop a new business relationship between primary and secondary care, the hospitals, as equal partners in a health care system based on shared and integrated care. Direct GP access to acute hospital services such as acute medical and surgical assessment units and pathways need to be developed. Over-reliance on the emergency department route needs to be fixed. Hospitals are there to support primary care, not the other way around. This culture change will take time but must happen through local discussion.

Such local engagement can be assisted through the Irish College of General Practitioners, ICGP, supported local integrated care committees, based on the Carlow-Kilkenny model where GPs, consultants and management work together locally to improve patient care. This should be funded and developed nationally. We need a formal agreed transfer of chronic disease management into the community. We also need to align information and communications technology between GPs and hospitals, a shared electronic health care record is vital for proper flow of patient data between community and hospitals. We need to ensure that primary care resource centres are developed to act as service and diagnostic hubs and that these are accessible to all patients and GPs in each catchment area. That is not the case for the primary care centres at the moment.

The Deloitte report to the Royal College of General Practitioners, RCGP, in 2014 showed that every €1 spent by GPs in primary care on people aged more than 65 saved €5 in the hospitals. This also gave better patient satisfaction and health outcomes. It is now recognised that we must make a decisive shift to GP-led primary care. All GP colleagues in the room today agree; and, the HSE, the Minister for Health and our health and social care colleagues agree.

This journey needs a ten year time frame and a new GP contract that supports this plan. It needs ring-fenced funding to make the transition. It needs political certainty to succeed. GPs are ready and willing for the challenge. That is why we are here today. We hope we have provided some clarity on the challenges but, more important, on many of the solutions to achieving a health care system we can all be proud of. We look forward to your questions on any of these matters.