Professor Anne Matthews:

There are similar issues regarding the flow between GP services and emergency departments. The complicating factor in that regard is whether people are paying for their GP or paying an emergency charge. They are making slightly different decisions. The emergency departments are under huge pressure, however. Similarly, it is not where people should be finding things out. That should happen way back at the community level with the primary care team.

There have been a lot of developments in that enhanced community care with greater nurse-led services in primary care, that is, the general practice settings and other public settings, for things like chronic disease management, which can be fully nurse-led and nurse-delivered. It is just about that whole capacity issue.

From looking at workforce planning over the years, general practice is so vulnerable to retirements. People are unable to take holidays. When more female GPs wanted different hours of practice, that was built into these workforce models, which were showing a massive strain over the past ten years, but that is increasing. There are definitely the same pressures as well about people trying to find suitable homecare that is funded by the system to the same level as funding for nursing homes through fair deal or other provisions.