Dr. Brendan O'Shea:

It is the consensus within the ICGP that general practice reached a tipping point during 2015, due to the onset of the under-sixes contract, influenzal activity, advice from hospitals for patients to attend general practice and increasing volumes. We have a more detailed submission which we hope is mercifully short. It includes an analysis of the situation, but we are interested in solutions this morning.

We know the problems facing the health care service and we refer members to the briefing document. We also believe we know the solutions. In the accompanying briefing document we have outlined solutions for primary care based on the following headings. The first is the cost efficacy of general practice. A well developed general practice is a key feature of higher performing health systems than our own. Another part of the solution, as my colleagues have outlined, includes building capacity in general practice. We have 3,900 general practitioners and approximately 1,700 practice nurses who work largely on a part-time basis. We believe that if want to deliver chronic disease management in this country and if we want to unburden the hospitals of primary care work and bring it into the communities we probably need closer to 5,000 general practitioners and, arguably, 5,000 full-time practice nurse equivalents. The ratio between general practitioners and nurses in general practice in the United Kingdom is closer to 0.8 while in Ireland it is closer to 0.2 or 0.3. We are seriously understaffed in both grades, in particular practice nurses.

Another part of the solution is to extend the use of information technology out of general practice where it is well established and into all other parts of the health system. A further part of the solution to the problems that are being faced by the health system is delivering care where people want it. People want their care to be delivered in communities and closer to home not in hospitals. We believe building on current experience and expertise is part of the solution. We need to move on. The key issues facing general practice and primary care are recruitment and retention.