Dr. Mark Murphy:

The next four paragraphs outline what we believe to be stronger primary care. This will resonate with what the committee will hear from us, the IMO, the NAGP and ICTU this morning and in the context of the reports with which it has been involved during the past year.

The first feature relates to capacity, which predominantly relates to persons. Health care is provided by persons, namely, GPs, nurses and other allied health care professionals. We spend €1 billion on drugs and another €600 million on high-tech drugs. Most health care is delivered by people and we need to invest in those people. The ICGP has played its part in this regard. Applications for GP training increased from 285 to 421 this year. We are doing our best to paint a positive picture of general practice. However, we need all these policies to come into place so that we can retain them into the future. It is not just GPs. We need a lot more practice nurses and we will work with the IPNA to develop and train those nurses. That is a priority. Capacity is not just persons though, we need better information technology. When we take on more workload and capacity is increased, we need our premises to be expanded and that needs to be supported.

Our second point relates to the independent contractor model. There is much discussion regarding model to use and how are we going to employ and pay for these services. Most countries' health services use an independent contractor model, even the NHS. We have an independent contractor model. To enable GP-led primary care, we need to bolster and improve the current model. We need it to be supported with increased numbers of practice nurses and other staff within the GP environment so that we can provide unfragmented comprehensive continuous carer to patients.

Our third point is that we need to shift care from hospitals to primary care settings. What are we talking about? We are talking about people with multiple chronic conditions. People who have six to ten chronic conditions who are on ten to 15 medications. It is the majority of our workload in consultation. In the final years of their lives, people can be over-medicalised in a hospital-centric system. If we want them to have the care they deserve, with their preferences and their quality of life maintained, we need to support the generalist approach to health care. That would allow us and the teams within general practice to care for those persons and that needs to be reflected in a new contract.

We need that capacity to be team-led within general practice. The GPs, practice nurses and other allied health care professionals need to be supported. In particular, practice nurses need better terms and conditions and that needs to be reflected too. This will develop a stronger primary care system.