Dr. Brendan O'Shea:

General practitioners are at the heart of the Irish health care system. Every day, thousands of people all over the country get to see their family doctor without a significant wait, getting quality attention and care for urgent and pressing problems. To ensure that we can continue to provide that cradle-to-grave service to an expanded population with more challenging conditions, and address our retention and manpower crisis in general practice, we urgently need to commit to greater resources and a new contract. In this submission, we will show the committee what that expansion means, what the challenges are, and what our legislators need to do to ensure that general practitioners and their practice teams can continue to be at the heart of a reformed and improving health service.

It is the view of the college that the remainder of primary care, the secondary care sector and the broader health system will never function safely, efficiently or effectively unless adequate capacity is built in GP-led primary care. In addition to chronic underfunding of GP-led primary care over decades, there are separate intractable difficulties regarding the way that secondary care is delivered in the Irish health system, and it is not the task of GPs or primary care to fix these hospital-related problems.

Protracted and grave difficulties relating to critical bottlenecks in emergency departments, in waiting times for most public hospital services, in sub-optimal health outcomes, in perceived and actual gross inequalities in access, and in well-identified system risks arising from overcrowding and health care-acquired infections will all continue as the inevitable consequences of a hospital-centric system where decades of systematic under-resourcing of GP-led primary care are clearly evident. This is what we have done badly in the past.

Specialist services, referred to as "consultant-led", in a hospital-centric model, remain, and will continue to remain, unable to safely or effectively address the present volumes of clinical workload. Much of this workload is best addressed in the community setting, not in hospitals. It is best delivered by teams of GPs and practice nurses working in a generalist, not a specialist service, and based in practices that are adequately supported by administrative staff and allied health care professionals, with access to diagnostics, so that more of the health care needs of most people can be addressed in the community, closest to where they live and at the most appropriate levels of cost and complexity. If we want to do it expensively, we should do it in a hospital.

Strong international evidence from various health systems exists in respect of developing a system based on strong GP-led primary care. Development of universal access to strong GP-led primary care delivers substantial benefits to all citizens and must now be considered as relatively inexpensive in the context of whole-system health care costs. In our statement, and the accompanying briefing documents, the position of the ICGP regarding the expansion of primary care is set out in detail.

Initial steps towards achieving a health system based on GP-led primary care must involve the immediate reversal of cuts introduced under the FEMPI legislation and the replacement of our 39 year old GMS contract with one that addresses both the needs of people who have an immediate need for ongoing medical care in their communities and those of the general practice teams. These two issues - FEMPI and contracts - are constantly to the fore in our consultations with our members, with allied organisations - including the GP representative organisations, namely, the IMO and NAGP, and the Irish Practice Nurses Association, IPNA - and in our engagement with other health disciplines within the health care sector. It is the view of the ICGP that FEMPI legislation has destabilised general practice, most acutely in rural and deprived communities.