David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I acknowledge the good work done by the ICGP, GPs, general practice staff, including practice nurses, and all those who work in primary care. We accept that, if we get primary care and the relationship between it, the enhanced community care system and community care right, we can take substantial pressure off our acute hospitals. What is happening in emergency departments is stark. A HIQA report out today again shines a spotlight on how bad the situation is. If we look at emergency departments solely through the lens of what is happening in our acute hospitals, we miss the point that many people are in emergency departments because they cannot access care elsewhere.

If we get this right, we can start dealing with the challenges across the healthcare system, but we must be honest about where we are with general practice. I have listened carefully to what has been said, so what I am saying is not meant to paint a negative picture, rather to point out the stark reality of our situation. We have an ageing profile of GPs, as acknowledged by the witnesses, and there is increased demand on general practice. General practice is evolving constantly and we want it to do more, but we do not have enough GPs, ancillary staff or the necessary infrastructure to meet existing demand. A younger generation of graduates want something different - a better work-life balance and greater flexibility. Our GP contract is, to say the least, archaic and needs to be re-examined completely. I hope that the expert or strategic group that is being established will examine all of these matters. Targets are being set for the number of GPs we need. We know what we need, but we have no plan to get there. It strikes me that we have a plan without an engine, which means it will not get far.

In a few months' time, we will have the single largest transformation of free GP care in the history of the State, when 400,000 people will be issued with GP visit-only cards, which I imagine will place more demand on the system. I believe the witnesses cited a figure of 600,000 plus consultations. Workforce planning will become a problem in this area of healthcare. We have discussed workforce planning in respect of other areas of healthcare. It is the single greatest challenge facing the system. Despite all of these challenges and capacity deficits, though, I see no plan of substance. The ICGP has targets and knows what needs to be achieved, but I do not see the resources or capacity required. We will not train enough people or get close enough to the other targets to achieve any of the objectives and targets that the ICGP has set, which I imagine are based on need.

Keeping with the metaphor of a plan without an engine, and given the capacity constraints and that, in a few short months' time, we could be looking at significant additional pressures being placed on GPs because of the issuing of more GP visit-only cards, is it possible that the system could crash? Perhaps "crash" is too strong a word, but will we be facing more pressures on top of what we already have?