Michael Harty (Clare, Independent) | Oireachtas source

I have two questions on Sláintecare for Dr. Wren and then some for Professor O'Dowd. Sláintecare promoted universal care delivered on the basis of need not the ability to pay. That was its founding principle. One of the principal recommendations of the Sláintecare report, as with many others, is that there must be a fundamental shift from hospital care to primary, community and social care. I think that is accepted. Another major chapter in Sláintecare related to integrating primary and secondary care. They are currently fragmented. There is a huge financial loss in the failure to integrate. If one integrates services, there will undoubtedly be savings. That is not to say the health service will be cheaper, but one will get better value for money if the service is integrated. Does the ESRI have the capacity to project the cost of adopting the Sláintecare reform plan? How long would that take?

One of the objections we hear from Government is it is a costly process. The first question we were asked is how much it will cost and when we said €5 .8 billion, which was our projected cost, the Government said it did not agree with our costings and would do its own. During the deliberations of the Sláintecare committee, the Minister said we would have to wait until the Sláintecare report came out before we talk about health reform. The report has come out; it is now nine months since it was published and the Minister has not produced his response to the report. There is a huge delay in implementing reform. One of those is as a result of costings. If the ESRI could project costings, it would be an advantage.

Can the ESRI project the number of GPs that will be needed should a universal system come into play in which there is universal coverage in primary care? How many GPs would be needed to deliver that, given the changing demographics and the unmet need we have at the moment?

The question for Professor O'Dowd is on the fact we are in the middle of a manpower crisis. It is not coming; it is here already. We have 660 GPs over the age of 60. Our younger GPs are looking at our GMS contract and saying it is a 24-7, 365 days a year contract in which the doctor pays for everything and takes on all the responsibility. I have a feeling the GP negotiations are not producing a new GP contract; they are producing chronic care on the back of the existing contract. That will not attract our young GPs in. Will Professor O'Dowd speak about that?

There is a difficulty with the visitation rates. The visitation rate mentioned was 5.63, but many people feel it is far more likely to be 8. If one is going to develop costings on developing general practice and one is out by 33% or 40%, it will lead to difficulties in costings. Will Professor O'Dowd refer to visitation rates, which refer to how often one has visited one's GP in the past year? It is an interesting question to ask patients because they cannot remember. If one asks a person how often he or she has visited his or her GP in the past two weeks or past four weeks, one will get an accurate answer which might produce more accurate visitation rates. Visitation rates to general practice refer to face-to-face contact with one's GP. If a GP sees 40 patients in a day, his practice nurse may have seen 20 or 25 patients that day. He may have made 20 phone calls which make material difference to the care of a patient. Combined, that amounts to 80 interactions. The nurse may have had ten or 12 interactions which affect patients' care. In that case, a practice has only seen 40 patients face-to-face but has generated 100 consultations. They are not picked up in any of the data but are a huge part of practice work.

Will Professor O'Dowd comment on the morale of general practice which is a serious issue at the moment and is inhibiting younger GPs coming into the profession?