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

I welcome the delegates, with whom we have had discussions on a previous occasion regarding the Sláintecare report. We were very conscious in examining proposals for a ten-year strategy for the health service that primary care must be at the heart of it. All the experts who came before the committee spoke about the need for an increased and enhanced capacity in primary care.

An issue that is critical in this regard is the number of GPs. That is determined by two factors, the first being a training programmes for the roll-out of new GPs and, second, whether or not there is sufficient remunerative attractiveness to retain GPs in this country. I do not expect the delegates to divulge where they are in negotiations, but if we are to roll out primary care as the bulwark of health care, then I assume the Sláintecare report and all that flows from it is central to those negotiations. Otherwise, we at risk of developing a strategy that cannot be underpinned by GPs and the primary care service in general. Will the delegates elaborate on where we are in terms of the recommendations in the Sláintecare report and how those recommendations are being mirrored in the discussions on the GP contract and its implementation? Of course, what is at issue here is not just the contract but the broader picture that encompasses practice nurses, nurse specialists and secondary therapeutic care in a community setting.

I am making an observation rather than a criticism in pointing out that the IMO is primarily concerned with representing its members. The Department of Health and the Department of Public Expenditure and Reform, meanwhile, have a view on what should and can be made available in terms of resources. It seems to me there is a critical component missing from the engagement between the parties. Does the Irish College of General Practitioners have an oversight view on the contract negotiations?

I assume the patient and clinical outcomes are critically important. I am not saying the IMO or the Department will not take them into account but, at the same time, we need some independent clinical oversight in terms of outcomes for patients and what people believe is the best for patients as opposed to the best for doctors or the Department of Health. I ask the witnesses to expand on this a little.

Reference has been made to the increased number of GPs in training programmes. I know the views of the IMO and others on salaried GPs, but does anybody see a role for salaried GPs, particularly in view of the fact we have huge challenges in socio-economically deprived urban areas and rural peripheral areas where it seems to be impossible to attract GPs? Even if we unwound all of the FEMPI cuts imposed on GPs in recent years, would that be sufficient to bring doctors into the areas where it is most difficult to recruit?

We speak about dispensing GPs. Is that role being diminished or undermined? Is there a need for greater emphasis on dispensing GPs? I ask the witnesses to elaborate.

With regard to practice nurses and nurse specialists, we speak about chronic care, chronic disease, enhancing capacity and moving patients from our hospital-centric system and out into the community setting. Realistically, do we have the expertise in terms of GPs and nurse specialists? How much of an increase in personnel would we need to allow for movement from the hospital system to a primary care setting in a structured phased manner? Have the witnesses done work on this? The risk is if we invest and front load primary care and it does not work, we will have a system whereby we have heavily-funded primary care but it does not deliver the savings required. This is a risk for policy makers. I know there is international evidence on this, but it has to be done in a way that works. This is why, in the context of the negotiations, there has to be some independent assessment of what is being negotiated in terms of patient outcomes and outcomes for the health services in general.

We looked at diagnostics in the Sláintecare report, and observations were made by the IMO and the National Association of General Practitioners and others in terms of access to diagnostics. Will the witnesses elaborate as to what they envisage in this regard? Is it the case there would be diagnostic centres or would they be attached to hospitals? Would it still be referrals through consultants? How exactly do the witnesses see this working in terms of diagnostics? Do they think there should be some form of diagnostic centres separate from the hospital system so people could be referred directly for diagnostics, as opposed to diagnostics been dependent on the emergency departments of hospitals? I ask the witnesses to elaborate on this.

With regard to prescribing, we seem to have high dependency on antibiotics and benzodiazepines. Are we out of kilter with other European countries on prescribing? Are there reasons for this? Is it the health of the population or the demographics? Is it our prescribing habits? There is a lot of evidence now with regard to reducing antibiotics. There are campaigns and some GPs are very involved in it. We seem to prescribe benzodiazepines and other medications more than other European countries.