Dr. Ronan Fawsitt:

We support the principles of the Sláintecare report, which is a coherent statement by the body politic to say that we need to develop a different health system based on primary care in collaboration with secondary care. There is no question about that. The argument has been won, and I congratulate our politicians for that. Uniting the body politic behind that vision and allowing ten years for it to happen is a very good thing. However, we cannot wait ten years to deliver the recommendations in the report. It just will not happen. In our presentation we provided a graph outlining the reasons why it would not happen. The reason is demographics. In the next 30 years our population is going to grow substantially. In particular, there will be more people in the over 65, over 75 and over 85 categories. Most of those people are going to get chronic disease. Some 65% of people over 65 have two or more chronic diseases. How will they be managed? Most of them are going to end up in hospital if we continue the current model where chronic disease is managed by hospitals. That means that the number of bed admissions is going to go up very dramatically in the next five, ten or 15 years, and it is scary that bed usage is going to go up by 120% in the next 25 years. We do not have the capacity in our hospitals or in the community at present to manage that increase. It would involve building six 1,000 bed hospitals the size of Croke Park and manning them with doctors, nurses and staff. It cannot be done. We have to make a change and start managing chronic disease in the community in a better way.

The Deputy rightly asked about the capacity. I had a conversation with a very senior person in the acute hospital division a year ago, and he said to me that our acute system has two winters left. We all know what happened last winter. Flu is coming.

Deputy Durkan asked what we can do to reverse things immediately and create a sense of confidence about general practice. The reversal of the Financial Emergency Measures in the Public Interest, FEMPI, legislation would help at this moment, or a commitment to reverse it without precondition.

He also asked about fees. It is a thorny question. We have a Victorian system where our nurses, who are our most valued asset in our practice, are not valued financially in the same way because we do not have the resources in general practice to do so. Some 4.6% of the health budget is allocated to general practice. In Scotland it is 6.5%. In England it is close to 8%. Other systems are way above that. We do not have the resources and we are chronically under-funded.

Someone asked how many teams we need. The primary care report recommended 400 to 600.

The question of turning away patients on a Saturday was mentioned. That is based on the contract, and it is mad. It should never happen. Patients should be seen when they need to be seen.

A Deputy asked why we struggle. I have 40 slots a day to allocate to my patients, and those slots are full. My practice nurse has 35 slots and they are full. We have 0.3 nurses per average list. It cannot be done. How can we take on chronic disease management within the current budget? It cannot be done. We need to front-load funding into primary care, by legislation, and into general practice-led teams. This is not about putting money into my pocket. It is about putting money into practice nursing, into the allied health professionals, into administration, IT and everything that is needed to provide a modern health system fit for the 21st century.

Senator Colm Burke asked about building co-operation. We must build co-operation between the representative bodies. There is no difference between the NAGP, our sister organisation, the Irish Medical Organisation, IMO, or the Irish College of General Practitiioners, ICGP on the way forward, but we need to fast-track this triangular system where we are all in different rooms. Deputy Kelliher asked me, when I presented on the Sláintecare presentation on integrated care, who would do the governance and what is really needed for primary care. I believe the ICGP is well placed and should be part of the contract negotiations in an advisory capacity. It is able, has the insights and has the confidence of all GPs. They need to be involved formally in the process in some way to build confidence going forward.

Deputy Durkan asked what three things are needed immediately. I like a man who goes to the point. What do we need immediately? After a decision to reverse FEMPI, which would create confidence for young GPs to stay here - and Maitiú will talk about that shortly - we need access to diagnostics. It is a disgrace that an intern in a hospital can access an MRI or CT scan and I cannot. I could not even access a brain natriuretic peptide, BNP, test, which is a heart failure blood test, until we negotiated through the local integrated care committee, LICC, in Carlow and Kilkenny and made that happen. Diagnostics need to be streamlined.

Our practice nurses need to be developed and increased. The idea of putting 900 community nurses out there into another silo in the community is mad. They are great people. Please, give them to general practice. We will use them well, make them feel good and connect them in an integrated system.

We also need rapid access to consultant advice and treatment when we need it without the hassle involved. I am a senior decision maker with 30 years experience. I know when an appendix is an appendix. I should not have to send a patient into the emergency department to be triaged by a junior nurse or doctor. It is mad. We have an integrated service in Carlow-Kilkenny which is called the acute floor. We have negotiated direct access for GPs to the acute floor so that patients are screened for medicine, surgery, paediatrics, observation, psychiatric care or whatever else they might need. It is a no-brainer, and it could be developed everywhere. We need direct access to consultant advice, both in the acute system or in scheduled care. In Ireland East we have the same vision. We need to develop services in the community for chronic disease, and one of the things we have worked on in the last year is a virtual clinic for heart failure. This is being developed in Carlow-Kilkenny and in Ireland East with Mary Day and Ken McDonald. In the first 270 consultations which were referred 90% were heading for the acute floor or outpatient departments, OPDs, whereas 90% are now managed in primary care without ever having to go near the acute floor or the OPDs. This involves a culture change, with the GP, the senior decision maker, being involved with the consultants in a process, along with the diagnostics, access to echo and a community nurse who can come in to assist us, and we can build the services from the ground up. Those three things are what are immediately required. Most of them are culturally wrong.