Dr. Mark Murphy:

I will address the Sláintecare issue, recruitment, retention and a few other questions. There were 19 in total. I will be very quick.

To contextualise it, take a 70 year old woman who has five medical conditions: obstructive pulmonary disease, arthritis, diabetes and high blood pressure. She would be on 19 medications at five different times in the day. She would be on 15 non-pharmacological medications. There are 16 interactions between her conditions and her drugs. That is the typical model of managing her care in a secondary hospital. Sure, we can manage single diseases in the 40s, 50s up to 70s, but what we can also do is integrate all that knowledge together. When one talks about prescribing, over 20% of over 65s are now on ten or more medicines. We have had an ever increasing rise in prescribing but what we have actually seen is a reduction in potentially inappropriate prescribing - that is from a large paper published in Ireland last year the reference for which I can give to the committee. GPs are doing a better job of managing all these complex pharmacological interactions. We can probably do a better job if the members give us the resources for chronic disease management and to be able to manage medicines.

Benzodiazepine is an issue. On quality prescribing, we will always stand over quality and standards. There is a big issue with legacy prescribing. It is hard to know what to do with someone who has been on a benzodiazepine for 30 years. It is a difficult issue. Certainly, going forward, that is not an issue anymore. We are doing a very good job. We would be benchmarked against our peers.

On the e-health issue, most of the issues we need to deal with relate to communication. That is what a telephone call can do. One does not need novel communications to do that. We can just pick up a phone. It is a pity that has been lost in some rural community hospitals. However, we do need data to have formal and structured and unstructured communication, and the HSE has enabled that. On the secondary care side, there is still no consultant with an email address. We have one.

We collect so much data. We need to use that data in research to underpin the quality of care. It is a shame that is not happening. We want that to happen. We need our electronic health record to communicate with secondary care - those are called summary care records. That needs to happen and we want it to happen.

There will not be a big role for IT to help with diagnostics. In terms of diagnostics, we are really talking about laboratory tests on both bloods and urine, we are talking about radiology including X-rays, ultrasounds, CTs and MRIs, we are talking about cardiac investigations and we are talking about gastrointestinal endoscopy investigations. In general, laboratory tests are okay. Some services have a courier a couple of times a week. It needs to be better and we can do near testing.

However, the real shame comes into more complex radiography. We do not have access to CTs and MRIs. Those patients end up in outpatient and emergency departments. They get sicker and it is an absolute disgrace. Much good work is being done in terms of endoscopy. Wherever it happens, we just need patients to get those tests. We are flexible with that.

On an issue to do with the salary of GPs, I am not sure that the thesis is correct that there are areas in the south inner city and north inner city that are crying out for GPs because we need a salaried doctor model. I have looked into this. I am a 37 year old GP. I would like to set up. The business model is not there. That is because of ten years. If one fixes the problem which is that the risks are too great and the rewards are too little and if one fixes the business model and comes up with an innovative start-up package in urban areas, that will fix retention in the inner city area. In rural practice, it is different. One needs other types of supports to cater for those and that is a particular issue. There may well be a need for salaried doctors, but my gut instinct and the instinct of our members is that if one fixes the independent contractor model the rest will follow. There is an issue with premises and set-up costs but that can come on.

The last point I will touch upon is the primary care team. To contextualise it, why do we need to talk to our excellent colleagues. We are talking about the community pharmacists. I talk to them over the phone. When I make an error on a script, they will ring me and we talk, and I will sort it out. That is the communication. We do not need any more communication with them. It is already excellent. With the physio and the public health nurse, we do not need to be in the same building. We are talking about complex, perhaps deprived and very difficult social issues or very elderly patients with a lot of complex needs.

We just need to meet once every month. It is not something for which we need to be in the same building. Too much emphasis is placed on geographical co-location. We just need to be able to pick up the phone, know people and have a little bit of time. We can then sort out all that stuff. We do not have to be under the same roof to do that. Although it would help, it is not the big issue.