Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and thank them for their presentations. I have the privilege and honour of also being a member of the Committee on the Future of Healthcare. It is an exciting time in terms of the discussions that are taking place. Everybody around the table will, I am sure, have a similar view in regard to how we deal with the changing demographics, the increase in population and transferring chronic disease and chronic illness from the acute system into the community and primary care system. We are all agreed, and all of the reports and evidence would suggest, that this is the right thing to do. How we implement that plan and the transitional phase will require an awful lot of front-loaded funding in terms of enhancing primary care. There is not much point enhancing primary care if all of our GPs are in Canada or Australia and so we are faced with a huge challenge.

Along with that, we are not training enough GPs. This is not about retaining what we have, we need to expand capacity substantially. Reference was made earlier to the need for an additional 1,000 GPs. If we are to be honest with ourselves, there will be challenges in terms of ensuring that every practice is viable. That is always going to be a challenge. In that context, perhaps the witnesses would elaborate on their views on the difficulties being experienced in terms of recruiting GPs in certain areas and on GP salaries.

The bulwark of primary care is delivered by GPs in their surgeries. This is based on a 44 year old contract. I am aware of the ongoing discussions and negotiations on a new GP contract. Let us be under no illusions, that is the critically important component in the delivery of primary care. If that contract is not remuneratively advantageous or at least attractive, GPs will continue to flow outwards. In that context, who in the negotiations is examining this issue purely from the clinical aspect? In other words, who is advocating for the policies? With the best will in the world unions are unions and they will advocate for their membership first. In terms of our attempts to ensure there is enhanced capacity and so on in primary care, who is the voice of reason in the context of the negotiations in terms of what will and will not work? Does the Irish College of General Practitioners have a role in that regard? I previously raised that question with the Minister and he said he would consider it? Whether that is happening or not, I do not know.

The National Association of General Practitioners has 1,900 members. The IMO has 1,600 members. Leaving aside all of the bartering and toing and froing in advance of the negotiations about representation and so on, are both parties equally represented at the negotiations? Is there a lead negotiator or is there parity of esteem? The witnesses might elaborate on that point.

If would be extraordinary if after all of this, half our GPs are outside the door and looking in the window. If we are to get this right, the negotiations will have to be as representative as possible. If one organisation is involved and the other is not, the committee will have to raise the matter. It would be wholly inappropriate for us to be discussing the most important issue facing the delivery of our vision for health care if all GPs are not represented in the negotiations on the new contract to ensure it is teased out to the point where everybody gains. I include in this regard the Committee on the Future of Healthcare and the plenary debate of its report in Parliament following publication. This means the negotiations need to be as broadly representative as possible. If it is not the case that all GPs are represented, the committee will have to have a discussion on it with a view to raising it with the Minister.

Reference was made to the Kilkenny model.

Recently, we discussed with consultants appearing before the committee the issue of GPs coming to the hospital, working with the hospital and greater links between consultants in the acute system and GPs in the primary care system. There is also the matter of access to diagnostics. We have heard varying views on access to diagnostics for GPs. Some people say it is critically important while other clinicians of equal eminence say it is not necessarily the best way to go. When the witness speaks about access to diagnostics, what type of diagnostics is meant?

There is planned elective surgery, elective appointments and elective diagnostics. Whether that moves smoothly depends on the flow through the emergency department. If there is not a great flow through the emergency department the elective surgeries and diagnostics take place on time, but if there is a build up in the hospital they all fall behind. There were cases as recently as this week where breast surgery was cancelled just before it was due to take place. That is really traumatic for people. Should diagnostics in certain areas be separate from hospitals? In other words, there would be regional diagnostic units that would function away from the hospital setting and not be dependent on what happens in the acute system. Otherwise, they would be swallowed up again by the acute hospital system.

In addition to the role of the nurse specialist, is there a role for GPs specialising in certain areas as well, if we are to expand the GP service and the number of GPs? I realise that general practice is a speciality, but within that context there might be GPs who work in the respiratory area, for example. Is there a possibility that one could build expertise in hub areas within primary care as well? Perhaps the witnesses would elaborate on that point.

Finally, what is the view of the representative bodies on the role of community pharmacists? I accept there is a substantial difference between diagnosing and dispensing, but they spend a great deal of time in college too and most of them are quite bright people. In view of the fact that they have premises in almost every village and town in the country, could they play a greater role in the delivery of primary and community care, obviously under the guidance and lead of the GPs?