Dr. Brendan O'Shea:

As the time is winding down, I will keep my responses brief. On Senator Dolan's question on how we can get people more involved, the Irish College of General Practitioners has grappled with this issue for some years and we recently agreed an approach for 2017. We intend to establish a process in which we will approach some of the larger voluntary patient organisations to ask for assistance in identifying representatives of the public interest for appointment to our committees. We have some experience with this approach, which we regard as necessary and of vital importance, although it is also difficult, complex and challenging.

At practice level, I suspect that if Dr. Glynn were not here this morning and did not have to rush down to do an on-call shift and probably deal with some paperwork on his way, he might have more time in his practice to formally engage with the people who come to his practice. This means doing practice-based research, including on patient satisfaction, and meeting more patients, not in the context of their illness but in terms of, "This is our practice and what will we do about it." This brings us back to the issue of numbers and manpower. We need more general practitioners and nurses. If we get 5,000 general practitioners and 5,000 practice nurses, we will be able to operate earlier on in the life cycle.

To return to the question on what we could do that would make a difference, although we are spending enough money, we are spending it too late in the life cycle. I strongly concur with Dr. McGarry's observation in this regard. It is an educational and health care principle that the return on every euro spent on education in the first five years of life is €20, whereas the return on euro spent in adolescence is €4 and there is very little return for every euro spent on people aged in their 20s.

The same applies in health care. Understandably, we are spending a large amount of money on hospital-based care, on the care of advanced disease and on the complex co-morbid patient. We want to be able to deliver high-volume brief interventions in our practices. There is a strong evidence base for this when it comes to smoking and people who are overweight, but it is simply not getting done. We need to focus where we are putting our spending. We are asking the committee to bring us in line, up from our 2.5% closer to the 8% figure. In England, with Brexit and so on, they are going to a figure of 11%. We will deliver better value for money with our independent-contractor model.