Dr. Brendan O'Shea:

In terms of the college's response to the Sláintecare report, it is broadly supportive of Sláintecare in general and a more recent report, A Future Together - Building a Better GP and Primary Care Service, from the HSE. We have good reports and policy. It is a question of implementing them and moving forward.

Touching on some additional questions, Deputy Murphy referred to the difficulties of the people of west Cork. On unfilled positions in rural practice, salaried positions may be part of the answer. The overwhelming consensus among most GPs is to fix the independent contractor model. With respect to west Cork, there could be deprivation weightings or geographical incentives. One of the problems is that there are several different ways to fix this, but anything would be better than the paralysis of the past 39 years.

We were asked about closer working relationships with other health care professionals. The ICGP has conducted its own research on primary care teams. It is a lovely idea, but it is not working. Some 70% of ICGP members are positively disposed towards the idea of primary care teams, but only 13% indicated a positive experience for all of the reasons we have elaborated on.

I would like to discuss a contentious issue which relates to our experience as GPs with primary care physiotherapy and private physiotherapy. The primary care physiotherapist works on a paper-based referral system and there is a wait time of anywhere from two to 12 weeks. Patients come back reporting on it. Private physiotherapy is available with a mobile phone number, email address and telephone which is answered, and a patient will be seen on the same day. Patients report more positively on that. It highlights, in microcosm, some of the important differences between a State service which is managed in the way it is and some of the benefits of the independent contractor model. Private physiotherapists operate in the private sector.

We share the concerns expressed about corporatised general practice. It seems attractive in certain respects. They have nicer buildings and a bigger business imperative, but there is an evidence base around continuity of care. It must be what people want and, most important, continuity saves money for all of the reasons on which we have elaborated.

In respect of continuity of care, a problem for us in general practice under the current system is our interaction with secondary care. The secondary care system is paper-based. There are 7,000 junior hospital doctors, some of whom are managed and trained excellently well, but the system relies on them. They, too, repeat tests, bring people back to outpatients departments and feed into bigger waiting lists. That partly contributes to the difficulties we are experiencing in terms of accessing tests for our patients directly. A junior hospital doctor, who may or may not be supervised, has better access to important diagnostic tests than GPs.

With respect to the preamble to Deputy Kelleher's question, he very properly said that if we fixed the training issue and remuneration issue, things would work well. There is a third dimension to that which is particularly important to our junior colleagues. Our doctors coming off our training schemes, who are whipped up everywhere else and are top-quality graduates, will not work in a system where if one patient comes to me as a private patient and another as a public patient, I will worry for weeks about whether the public patient will get a colonoscopy or endoscopy. They will not make seven phone calls to a hospital to chase up results. They are leaving for the NHS, Scotland, Canada and Australia where all of these things work smoothly.

A big chasm between general practice and touching on one of Deputy O'Reilly's issues relates to information technology. We cannot emphasise the importance of this enough. Whatever we collectively decide here will not be perfect, but will almost certainly be an improvement. The quickest way to know whether something is working is information technology which is real time and data driven. Everything we in general practice and our nurses and administrators do is incredibly transparent because of electronic data. One falls off a cliff when one goes to the rest of the primary care team. The hospitals are a morass.

Members made several comments regarding the shift of care to general practice. There is an assumption that what is going on in hospitals is adequate chronic disease management, but it is not. We need to build capacity in evidence-based primary care which is data driven and involves integrated teamwork. The college is happy to revisit primary care teams in a meaningful way with our colleagues, the GP representative organisations and the HSE. We cannot support what is going on at the moment. Likewise, we are happy to revisit primary care centres, but for many of us they simply do not work.