Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome our guests. It is important to acknowledge the essential role that general practice has played in the health service down through the years. General practice is very much the front line and the first point of contact for people. Traditionally people have been vary satisfied, in the main, with the level of care being provided and the accessibility of their local GPs. The relationship between patients and GPs is a very trusting one. I say that notwithstanding the difficulty that many people have in accessing care as a result of cost barriers. That is very much central to the approach taken in Sláintecare. It is about removing the cost barriers but it is also about refocusing the health service away from the very expensive acute hospital system and putting a major focus on general practice. That includes doctors and all other essential healthcare workers at primary care level.

There are major opportunities for GPs to be part of something that is really transformative for our health service and that is what the public wants. It makes sense for people to be able to access care at the earliest stage when an issue develops for them. It also makes sense for them to have an ongoing relationship with general practice. In the main, people want to access care locally from people that they know and trust. That kind of approach is very much enshrined in Government policy and in Sláintecare and that is why it is really disappointing that we find ourselves in a situation where there is a commitment to vastly expand general practice and primary care but we do not actually have the staff to do that and there are real obstacles in the way. One of those obstacles is the current model of care. While acknowledging the fantastic work that has been done down through the years, it is also important to acknowledge that private contractor, single-handed practice is a model that is no longer attractive to younger graduates. There must be a way of acknowledging what existing GPs are doing, supporting them better in that while also developing a new model that recognises the desire and the needs of new graduates.

We know from the HSE's updated workforce plan of November 2020 and from the very extensive research that has been done by the ICGP that younger doctors do not want the kind of model that has been in existence from the beginning of this State. We have to recognise the fact that people are working to a 50 year old contract, albeit one that has been updated somewhat. It just does not meet the needs of patients or medical graduates. Research shows that medical graduates want a better work life balance and they want to be working in multidisciplinary teams with a much better skill mix. They want to be medical practitioners as opposed to business people.

Many of the people graduating from medical school are broke as it is because of the cost of that. They do not want to be in the position of having to take out a mortgage to buy a premises. They want to concentrate on providing healthcare, in the main. The proposals from the ICGP need very serious consideration. In the absence of updating the contract and the model of care, what has happened, as mentioned by all of the witnesses, is that we now have a severe shortage of GPs. The impact of that is that in areas all around the country people cannot access basic primary care. This applies in rural areas as well as in urban areas. As Deputies, we are increasingly getting queries from constituents who cannot get on to a GMS panel to access a general practitioner. We know that the inverse care law applies. The inverse care law is that the more people need healthcare, the greater the need, the less likely they are to be able to access that care. We know from the witnesses' colleagues in Deep End Ireland that there are serious, major problems in areas of high urban disadvantage. The existing model does not address that.

Because we are not addressing those key problems, we are seeing the corporatisation of primary care. That is not desirable. The big companies are coming in from abroad and running general practice. That is not in anybody's interest. Unless we address the fundamental underlying problems, that trend will continue and we will lose all of those good elements of primary care and general practice. We have to listen to what the ICGP is saying. Its proposal around a high-level working group to address these underlying problems is key. I would hope that as a committee we would take up those issues. The problems go much deeper than tax reliefs for the existing model.

I have a question for Dr. Quinlan. To what extent has the ICGP engaged with our many medical graduates in recent years who voted with their feet and have gone abroad to work in other healthcare systems that provide work-life balance, premises and opportunities for part-time work that younger GPs are looking for now? How much has the ICGP engaged with those people and what are the primary reasons for them emigrating?