Dr. Mark Murphy:

The Irish College of General Practitioners supports the Sláintecare report. Health has not been the focus and there has not been a political consensus in my lifetime, and I have been a qualified doctor for 12 years. For those who have been working since the 1980s, there has been no joined-up thinking with regard to health. I commend the Deputies and Senators here today on coming together to get a long-term vision. Taking a broader perspective, we saw Oonagh Smyth's documentary last week about inequality with regard to accessing secondary care. We know we need more orientation towards public health and Healthy Ireland. Obviously, the only show in town is to support the generalist to manage chronic conditions in communities with GP-led primary care, and we support Sláintecare's initiative.

There is one issue and that is capacity. It has to be done slowly in a phased way in order that capacity is not over-reached, so to speak. We want to tackle health care inequalities. The main danger would be if this was done too quickly. If we give free GP care to everyone, very soon we will end with a two-tier general practice system where someone working in the newly built primary care centre in Crumlin will be seeing medical card patients with a two-week waiting list while a fee-paying practice next door will see patients that day. I do not want that to happen and we need to make sure it does not happen, so it needs to be phased. We fully support Sláintecare and its goals of achieving a better health care system for all in a sustainable way.

In response to Senator Burke, the ehealth project in Cork exemplifies the core issue about ehealth. The GP gets the discharge immediately from the maternity hospital so there is no squiggle on a script that I cannot read. I get the discharge that day, not three weeks later. It makes sense. To our knowledge, the results are still coming in. There were some hiccups with the piloting and involving GPs, but this is exactly the kind of stuff we need and that Richard Corbridge drove through. It looks very promising.

In respect of econsultation, I must say very clearly that there is an issue with demand and supply in health care. If one keeps increasing supply of the wrong type of health care, it will just keep getting consumed. I am afraid there is no evidence for electronic communication being more effective than face-to-face communication. I can consult someone face to face or pick up a phone to communicate a result. I can send the patient a text message or email them or we can use a nice fancy tablet to look at each face to face. I am afraid a lot of econsultation is a corporate marketing strategy that overmedicalises things and will deliver care in the wrong way. It has to be done within the context of the GP team to follow up results and it must be evidence-based. There is a lot of this going around at the moment and it is a misappropriation of the term "GP". Insurance providers providing GP care through tablets is not GP care and we will not stand over that.

A point was made about negativity with regard to recruitment and rural practices. It is a double-edged sword. We have done our bit. We have engaged and tried to communicate what an important job it is and the joy it can bring even though it is very challenging. We have a campaign called #beagp. We have tried to put across that spin of the professional rewards that can follow. We have done our bit and are trying recruit and train more GPs, but we really need that other piece to follow. We need the funding and the whole system thinking and we commend Sláintecare to do that.