Dr. Ronan Fawsitt:

I would like to come in on that because it is critical. Professor Tom O'Dowd's TCD study said that 90% of patients were happy with their last GP consultation. Imagine if the politicians here were getting a 90% satisfaction rating. We are coming from a good base. We are trusted and valued. That voice needs to be in the implementation team. We are looking for GP representation and involvement in the implementation team because GPs are entrepreneurs. We get things done. We have a powerful impetus to make thing happen.

I echo Mr. Tony O'Brien's observation that we need €500 million annually over ten years for primary care development. We need to front-load transitional funding into primary care. Politicians have to take a punt that general practice can do this. We know we can, our patients - 90% of them - trust us to do this but the State has to invest in it. It has been done in other jurisdictions, such as Vermont and New Zealand where there has been legislation-led change. The people on this committee do not know how powerful they are. We cannot deliver the change that is needed without the support of the body politic. That is why Sláintecare, whether right, wrong or indifferent, is brilliant for having brought together the body politic and given us a vision for how to go forward. The body politic now needs to get people into that team and we are willing to put our hands up and get involved.

We need to develop a sense of population health. My population is my practice. I want to look after my practice. I know where my patients are, I know the sick people, the frail people, the COPD patients, the heart failure patients and mental health patients, but I do not yet have the team to manage them. The State has a population of those over 70 years and it could incentivise better care in the community. They are already State-funded through the over 70 years medical card. A start could be made with that population, and develop services around chronic disease in the community and manage them appropriately but the nonsense of the doctor visit card has to be stopped, which turns patients into second-class citizens without access to a public health nurse, occupational therapy or other things, because they have a second-class card. I would ask that they please be given a full medical card. Starting now, with a stroke of a pen, full GMS entitlement could be brought in for those over 70 years which would allow them to access whatever supports are already there in the community. Then GPs can be incentivised to provide more structured care. I will give one example of where we have made a proposal. We know that 70% of hospital work is medicine. Many patients are discharged after medical admission, and 12% of those over 70s are readmitted within 30 days. There is evidence that if those patients who were discharged after pneumonia, a stroke or whatever are seen by their primary care physician within seven days, the readmission rates are reduced by between 12% and 24%. That is joined-up care, joined-up thinking and is better for patients and for general practice. If we were resourced to do that extra care, it would cost very little but the reward is considerable and this is for a population whose care is already covered by the State. That is the kind of intervention and joined-up care that we need to promote, the idea that we have a population that we are responsible for, and we should put in the structures that can help them to stay well and out of hospital. International systems have shown that this works. That is what we should do.