Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I thank the witnesses for their attendance at the committee this morning and for the information they provided.

Reference was made about access to supports and therapies and that perhaps there is an increase in drugs being prescribed due to the lack of the therapies. Would this be true of drugs for pain management? In the absence of access to proper physiotherapy, are GPs finding themselves in situations where they now have to prescribe painkillers? Would we see a reduction in the amount of pain management medication being prescribed if the resources and personnel were available in the primary care centres and if there was a fully functioning primary care team that included physiotherapy and other therapies? We are aware that these services are not in primary care centres but would this be more appropriate? Could it be better managed if more supports were available in the community? Perhaps the witnesses could give their views on where those supports should be based and how people might be able to access them. I understand that the majority of supports that are provided are in the private sector and are for people who have the money, and that the supports are not available for people on medical cards.

We cannot sit here and not talk about the pain medication patch, Versatis. This issue has been in the media where it was highlighted that the level of use of the patch in Ireland is out of kilter with its use in other jurisdictions. Perhaps the witnesses could comment on this issue in the context of the availability of therapies.

I have another query that is related to the use of Versatis. Is it the witnesses' opinion that GPs want to be in a position to prescribe it but cannot do so? Clearly GPs were prescribing Versatis, and I am sure the witnesses will tell me the GPs were prescribing it in line with procedures and so on, and that is fine. They were, however, prescribing it and now they cannot. Are there other drugs such as this? Are GPs sitting in their surgeries this morning with medical card patients in front of them thinking, "I would like to be in a position to prescribe these drugs"?

Can the witnesses give an estimation of whether that is a problem? We are currently debating legislation on the eighth amendment. People know my view on that which I will not rehearse as it is not for this committee. In the event that the amendment is repealed, it is proposed to roll out a GP-led model. I do not propose to go into the merits of that, but will specific training be required of GPs and how long will it take? Are we equipped to upskill GPs in the event that the eighth amendment is repealed?

Dr. Murphy said that having controlled the issue for polypharmacy, the odds of potentially inappropriate prescribing in 2012 compared to 1997 have reduced by 60%. What he is saying is that, in essence, we are prescribing more drugs but getting better at prescribing them. How do we fit with the rest of Europe on this? What I have read in the newspapers indicates that we are out of line and have a problem as a nation with prescription drugs. I am sure Dr. Murphy has seen that. Clearly, we are not writing the prescriptions for ourselves; they come from somewhere. Perhaps Dr. Murphy could give us a view on that.

As to nurses prescribing, is there much interaction between the GP service and nurse prescribers? Are there many nurse prescribers in the community? Could we make better use of the skills of nurses within the community with regard to prescribing?