Dr. John O'Brien:

We do not want to be the dog in the manger. That is not the issue. There are issues around fragmentation which need to be taken on board. The reason a GP needs to lead primary care is not because he or she is such a wonderful thing, but, rather, because the model of general practice is one which provides for integrated care, which is what is proposed in Sláintecare. Integrated care depends on the GP delivering care in a holistic manner, which means that one is looking at all of the contexts of a patient's problems, be they biological, social, psychological or even existential. The model has to be comprehensive and deal with everything. A GP may deal with lupus, diabetes, oesophagitis or psychiatry. The care has to be totally comprehensive.

Another important aspect is continuous care. This is all within the European definition of general practice but I am distilling it down for the committee. Continuity of care is important because with each consultation another twist in the relationship with the doctor and patient takes place. All of that iterative building over a period leads to a resource which the patient can draw down during times when they are in difficulties. It also helps in terms of balance.

We discussed multimorbidity, which means that a person has a range of different diseases. If one is going to introduce into the community specialist nurses in cardiac care, respiratory care, diabetes or whatever else they will all follow the guidelines pertinent to their area of expertise. Who takes all of that, marries it together and integrates it for a single person? That is what a GP should be doing.

This brings me back to the issue of time. If GPs are not given enough time to do that, then they cannot do it. People will go on to waiting lists or into casualty departments where they should not be, which is another cost to the system. Savings can be made by taking a lot of funds out of general practice, but we lose out on a whole load of other things, including the budget, which is what we are discussing today.