Professor Cillian Twomey:

Regarding the preparedness of the community support teams, I do not think anybody was adequately prepared in February because we were just beginning to learn about what was about to unfold. However, we learned very quickly, maybe more quickly than some in other sectors did. A group we have not yet referred to in the context of the community support teams is that of general practitioners. The person in charge in a nursing home is the person HIQA identifies as such and, in a sense, that person is responsible for the totality of care in his or her institution. It is an onerous responsibility and assuming the role can be quite a lonely place for a person to be. If we expect people to take on that type of responsibility, we must have supports in place to ensure they can undertake it without being overly stressed. The role of the general practitioner is very important in this regard.

We currently have a situation where most residents in nursing homes have a GP assigned to them. Depending on the size of the residence, there could be ten, 12 or 14 GPs visiting the larger facilities and two or three visiting the smaller ones. There may be an urban versus rural factor in this regard. Those GPs provide care to their patients in the nursing home setting. We are strongly of the view that there needs to be a medical oversight role incorporated into the governance structure in nursing homes whereby the person in charge, who usually is a nurse, would have the support of a senior medical person, who should be a GP. We are suggesting that where GPs visit nursing homes, one of them would be identified as the GP lead in that facility and would be the go-to person for the overall review of adherence to all the standards HIQA has laid down and so on. Similarly, there needs to be a GP on the community support teams because GPs are the key medical link between the patient and medical care in the first instance. We recognise that this will put an additional onus on GPs who are currently overstretched in a context where there is not a sufficient number of trainee positions or established GPs. In recognition of this, we say that more places must be made available for general practice training and more GP positions must be created. This cannot be done haphazardly; it must be done properly.