Colm Burke (Fine Gael) | Oireachtas source

I thank the delgates for all of the work they have done in their comprehensive research and reports. It it appreciated.

My first question is about care of the elderly. The report states there are now approximately 640,000 people over 66 years of age and that the figure will be 1.1 million by 2030. The current ratio of people in nursing homes and community hospitals - there are approximately 23,500 under the fair deal scheme - is 27,000. That figure might be wrong, but that is the one I have worked out. On that basis, if by 2030 there will be 1.1 million people over 66 years of age, 46,000 nursing home or community hospital beds will be required. There must be a better way of dealing with this issue. Obviously, the way to deal with it is by expanding home care services. There is an urgent need to fast-track their expansion. That ties into the workload of GPs. If one expands home care services, one will also expand the amount of work GPs must do. Has there been consideration of how we should deal with that challenge? There would be a huge cost involved. The fair deal scheme costs approximately €1 billion per annum. If the number is increased to 46,000 by 2030, it will probably cost €2.5 billion or even €3 billion to fund it. There is also the issue of value for money. Is there a better way of doing it through home care provision? How does one improve it? That is an issue we must examine.

My second question is for Dr. O'Dowd. It concerns the lack of a connection between GPs and the hospital system. I recently spoke to somebody who works in Canada as a GP. If a patient is pregnant, the GP can go to the hospital and carry out the delivery. We seem to have a system under which GPs cannot even make a telephone call to consultants. I am not blaming any single group for this. I am not blaming consultants as they will say they are extremely busy and that it is not easy to set time aside do do it. However, we have a problem in training hospital doctors. Many are dropping out of the system, particularly out of obstetrics and gynaecology. I met two people recently who had spent six years training in that area and dropped out because of the stress levels and demands made. I met another person who had trained for nine years but who was going on to general practice training to become a GP. The people referred have huge skills, but there is no opportunity for them to do some hours in the local hospital in the area in which they live. There does not appear to be the same apparent disconnect in other countries. Has that issue been examined?

I was speaking to members of the National Association of General Practitioners and met some of the young doctors in the association, every one of whom was afraid of setting up practice on his or her own. They were afraid they would not have sufficient income. I put forward the idea of four three-hour sessions per week in a hospital, which would mean that they would know that they would definitely be paid. They were quite enthusiastic about that suggestion, but there is no system in place to allow it, even to allow them to work in emergency departments and establish that connection with the hospital. We do not appear to have done this. Should we consider it and look at how other countries do it, where there is a direct link between hospitals and general practitioners? That is one of the problems.

The other issue is that the composition of the GP cohort has changed substantially in the past ten or 15 years. There are many young GPs who have young families and are trying to achieve a work-life balance between working and caring for their young family. Does Dr. O'Dowd envisage a change in that cohort in the next ten or 20 years and, if so, how do we plan for it?

The next issue ties into that matter and relates to a GP working from 8 a.m. until 5 p.m. or 6 p.m. As a large percentage of the population find it difficult to get time off work to go to their GP, they tend to visit their GP after 6 p.m. Do we need to examine the hours GPs are available? I accept that they are available under the out-of-hours service contract, but the problem is that one will not see the same doctor each time. If one visits a doctor on a Tuesday, the same doctor will not be there if one returns on Thursday night. Do we need to examine that issue? How do we incentivise GPs to be available on a reasonably regular basis after 6 p.m? In fairness, some practices operate after 6 p.m., but many find it difficult to do so because of the demands on GPs. It is something we must consider.

The final issue relates to the roll-out of the scheme for children under six years of age. The big complaint among GPs is about how the scheme has increased the demands on them. They say that in many cases people are calling unnecessarily. If we are considering rolling out a free GP scheme for children under the ages of 12 and 18 years, what changes should be made to ensure there will be a balance between people who really need to see a GP and the overuse of a free service? It appears that if we roll out a free scheme for those under 12 years of age, it will create such a demand on the GPs that they will be unable to cope. For example, I heard from one GP that a family had called 19 times in a very short period. There was nothing wrong with the child, but there was obviously a concern on the part of the parent. It might well have been a genuine concern, but the GP felt the scheme for the under six year olds had created its own pressures and that GPs were finding it difficult. If we wish to extend the scheme to children under 12 and 18 years old, what changes should be made?

I again thank the delegates for the research they have carried out and the contributions they have made.