Dr. Pádraig McGarry:

The IMO thanks the Chairman and the members of the Oireachtas Joint Committee on Health for the invitation to discuss GP manpower and capacity issues in a properly functioning primary health care service. I am a GP in Longford and am also chairman of the IMO GP committee. My colleague, Austin Byrne is on the GP committee and is a GP in Tramore, County Waterford.

The argument that general practice is the optimum vehicle to deliver health care in the community setting has been made and proved without doubt and has been cited in a multiplicity of documents and research reports. That there is a capacity crisis in general practice in Ireland is therefore without doubt and this is manifest in the reality that practices and general medical service, GMS, lists, which heretofore would have attracted multiple applicants, can no longer attract a single applicant. In Thurles recently a practice of 1,200 patients which would have attracted a line of people a few years ago, cannot get a single applicant. That highlights the real problem.

The age profile of current GPs point to over 17% of current stock ready to retire in the next few years with little chance of replacement by newly trained GPs; 24% of GPs are over 60 years of age. Newly trained GPs indicate that they intend to emigrate to other jurisdictions where they feel their talents are better appreciated and their aspirations from a professional and financial perspective are more achievable. Newly trained GPs are also reluctant to commit to a health system which is failing as a result of the draconian reduction in funding foisted on general practice in the past few years. They would like to stay but circumstances are driving them out.

The resource cuts of 38% foisted on general practice have resulted in an inability to employ the staff required to deliver service to patients in a safe manner. GPs are being stretched beyond breaking point with workload and general practice is being shunned as a career by those coming out of college. They see what has happened. With an aging population, an additional 20,000 patients aged 65 years annually coming on stream, a cohort which brings with it additional workload, this situation can only deteriorate unless very clear decisions are made and implemented. The IMO has submitted a document which outlines the causes and offers solutions as follows.

The IMO calls on the Department of Health and the HSE to agree a strategy with the IMO for the development of general practice in Ireland in future decades. To ensure the maximum benefit for both patients and the health system the strategy must include a manpower action plan to address the growing shortage of GPs and to include an increase in the number of GP training places and an assessment of practice staff needs including assistant GPs, practice nurses, managers and other support staff. In order to halt the exodus of newly qualified GPs, priority must be given to negotiating a new GP contract with the IMO that is properly resourced and fit for purpose for a 21st century health service. Incentives must be provided for the development of infrastructure including premises, medical equipment, diagnostic equipment and IT, as per the recommendations of the Indecon report which was submitted last year. Access to diagnostics and allied health and social care professionals in the community are a necessity. There must be a commitment to preserving the positive traits of general practice, including the community-based same-day appointment service where possible, the GP independent contractor model and, the role of the GP as gatekeeper to the health system. Access to GP care should be expanded on a phased basis taking into account income and medical need rather than being based on age cohorts. All of the above must be resourced properly. That is the nub of the issue. I hope we can provide additional insight to the health committee and enable it to provide support for the suggested measures. We are happy to address the questions of members.