Dr. John O'Brien:

Increasing the numbers of GPs and practice nurses and providing additional sessional inputs from relevant health care professionals will enable better prevention, earlier detection, more immediate care in communities and a shift in mental health care from psychiatric outpatient departments, OPDs, if adequately resourced. Focused transitional funding is essential for this to happen, to increase training and improve retention for GPs and practice nurses. Legislators, administrators and patients can all be confident that given the highly computerised nature of general practice-led primary care, any additional resourcing can be supported by agreed full system de-identified data analysis. Stakeholders can thus be assured that funding is tied to agreed activities. This process is already well established in general practice in terms of the PCRS and Heartwatch data returns, and in the primary care research network activities.

It is the view of the ICGP that the financial emergency measures in the public interest, FEMPI, legislation has destabilised general practice, especially in rural and deprived communities. Within the NHS and many Commonwealth health systems as well as the Scandinavian and Dutch systems, the proportion of health spending in primary care is in the order of 8% to 11% of the total health spend, whereas in Ireland the proportion is in the order of 3.7% to 4%, less than half of the spend in the systems I have just mentioned. This striking historic under-resourcing of GP-led primary care in Ireland is an important rate limiting factor in improving mental health care for individuals and families at this point.

The ICGP is confident that given adequate resourcing for GP-led primary care, substantial improvements can be achieved in the experiences and outcomes for many people with mental health needs who use our health service. The college is closely aligned with best international evidence and with our own national policy framework. First must come the stabilisation of GP-led primary care through relevant and essential investment in building capacity, following which we can confidently implement key policies and continue to make real and positive differences to people who rely on the Irish health system to deliver their essential health care, particularly mental health care.

We have identified a number of action points for the committee to consider. The first is addressing the instability in general practice arising from cuts in funding under the FEMPI legislation. This is sometimes construed as GPs looking for money for their own sectoral interest. This is money for the people who come in to see us. It is so that we can provide the service we need to provide to these people. It is not for us. Second is replacing the present GP contract with an evolving contract to support the primary care needs of all citizens. Third, we call for the use of deprivation and geographical weightings to address the greater health care needs of deprived and rural areas. Fourth is extending the use of electronic medical records and administration beyond general practice to the whole health system. That is a very important component of the integration that is badly needed to avoid waste within the system. Fifth is the provision of adequate sessional allied health professionals in GP-led primary care, especially counsellors and psychotherapists. Sixth is to review and appraise the functioning of primary care teams, increasing input from mental health practitioners. Seventh is ensuring that mental health is effectively reflected across all evolving chronic disease programmes. Mental health does not exist in isolation but is co-morbid with a whole load of other conditions. Eighth is to increase the numbers of GPs and practice nurses towards 5,000 whole time equivalents of each. This is important to provide the time people need to articulate and have heard the problems with which they are presenting in primary care. Ninth is to stabilise staff turnover in all psychiatry services, reducing dependence on non-consultant hospital doctors for service delivery.

What we are trying to address here is the frustration that patients feel at seeing different staff on subsequent iterations of their care within secondary care. It is a common and big problem. Tenth, we should critically appraise care pathways in all psychiatry services, which at times appear profoundly disjointed, often because of resource problems or staffing problems, but which have the net effect of deflecting those who need a service from getting it.