Dr. Pádraig McGarry:

With regard to Deputy O'Reilly's question on IT, general practice has been to the forefront of developing IT independently for years, and we are way ahead of our secondary care colleagues. Most general practices are now computerised. There is no interaction, or very little interaction, between secondary care and primary care from an IT perspective other than IT referrals. It is improving and certainly Richard Corbridge had a vision that it would improve. Unfortunately, to date, we have not seen a huge appetite for it to happen. It needs to happen because it is front and centre to all of the other issues on chronic disease management and referrals. GPs have been to the fore in investing their own funds in this. Uniquely in the health service it falls on them, and certainly it is an issue which is very much to the forefront in the initial discussions and consultations on the GP contract. This has been acknowledged by the Department of Health and the HSE. It is very much an issue that will need to be addressed, or else it just cannot go forward.

With regard to primary care teams, Dr. O'Shea mentioned we are very much IT based. Primary care teams can be all paper-based, and people felt the meetings taking place between allied professionals were not working out terribly well. They were not structured terribly well and there was very little outcome from them. This can be developed and needs protected time. In a lot of cases, the meetings could be done through Zoom or Skype. IT can help in this.

With regard to allied professionals, I work in a primary care team and quite often the allied professions to which we would like to refer patients just do not exist. If somebody goes away on sick leave or maternity leave there is no replacement and a physiotherapist, dietician or podiatrist just does not happen to be there. The whole system breaks down. We start developing what we have never wanted to do in general practice, which is waiting lists. If we are going to create primary care teams we have to protect whole-time equivalents to make sure that if people do go away on whatever leave they have that there is a back-up and fallback position. At present this does not exist.

A question was asked on the corporatisation of general practice. There has been a move in this regard and I can understand it. Many GPs in their mid-50s and coming into their 60s have invested heavily in their practices over the past ten or 15 years with the hope and expectation it would be funded appropriately. Many GPs have found themselves in dire financial straits and certain corporate entities have provided them with an exit strategy which otherwise just is not there. If general practice was properly funded the traditional follow-on, if it was financially viable, would be likely to happen. Unfortunately, trainee GPs and younger GPs do not see this happening so there has not been a natural progression from trainee GPs to younger GPs to principalships because of the uncertainty that exists. Corporates have come in and offered exit strategies to GPs in that situation. There is a danger in this. There is anecdotal evidence that initially when GPs go into corporate practices it looks fine, but they lose their autonomy.

Many GPs who have gone into corporate practices after a while find that this is not what they bought into. I suppose it is the individual care that GPs give all the time that attracts them to the job.

Corporates will respond to financial imperatives. There was an example from Scotland where a corporate group bought up 25% of the practices in an area and it went broke. The government or whoever was left to pick up the pieces. It is a huge risk. If one ensures the financial viability of 2,500, 3,500, 4,000 or however many GPs are there, one is much less likely to run the risk of the whole system imploding. Some, for whatever reasons, perhaps making wrong decisions, may not necessarily survive but, by and large, if one allows appropriately funded practices to flourish, they will remain in place. By opting for the corporatisation, one runs the risk that the corporates may move on.

The other issue in relation to that is, from a clinical point of view, there is a loss of that continuity of care which is so important to the patient. It has been well documented that having one's own GP on an ongoing basis leads to much better outcomes in the long run. There is a huge risk that, if corporatisation comes in, that will be lost and the cost to society in general can be exponential.