Mr. John Hennessy:

I will try to address the four or five questions on primary care. I will then invite Dr. David Hanlon to comment on a number of these issues from his own experience as a practising GP and also as the clinical lead for primary care.

I will start with Deputy Kelleher's point on the big question of why people are going to emergency departments if they could be cared for elsewhere. It is a question that has been having a lot of discussion and debate at the task force, as the committee can imagine. Clearly, people attend because they need care and treatment. The challenge for us is to ensure people can get the care they need in the most appropriate manner and the most appropriate place. For that reason, as part of the task force and under our service planning process, we have been working hard at developing and creating the capacity in primary care to fulfil that challenge.

Some of the measures will be familiar to committee members but they include, for example, the improved access to free GP care, on which we have seen developments in the current year, and the development of the GP out-of-hours service. To be fair, this has come a long way in the past ten years, from a time when each GP looked after their own arrangements to a far more structured arrangement where we have call centres, cars and drivers and clinical governance, and there have been enhancements in the current year in the north west in particular. It is a service that costs in excess of €100 million per annum and a review is under way and is due to conclude in 2016. I am hopeful we will use the findings of that review to look at issues like effectiveness, cost, value and so on to inform our future approach to GP out-of-hours cover.

That is not the only service. The activity of the community intervention teams has increased by 30% this year and will expand further in 2016 when we expect to treat 24,000 patients. Alternative diagnostic access for GPs is in the package, with, as the director general mentioned, 16,000 treatments this year and further expansion in 2016. Chronic illness management is part of the process of providing care for patients outside of hospital and, it is hoped, avoiding the necessity for patients to attend hospital for their routine chronic illness care. Diabetes is the most obvious one of these, and we have seen developments in the current year around that. End-of-life care is also part of that approach, in particular ensuring alternatives are in place through the palliative care service for end-of-life care without resorting to hospital access.

One of the questions focused on the ambulance service. An ongoing discussion, courtesy of the task force, is examining why all roads for the ambulance service lead to the emergency department. If we can create options and alternatives on that front, obviously we would like to do that.

The approach that is being taken under the auspices of the task force is to create capacity in primary care that will help avoid the necessity for people to attend acute hospitals. Again, some of that process involves changing clinician behaviour, whereby some of the practices are directing patients to hospitals who perhaps can be diverted elsewhere.

Deputy Ó Caoláin raised the out-of-hours service, which I have covered in terms of what we are doing on that front. Deputy Healy mentioned the community intervention teams and where they are located. I have a list of the ten which are currently operating and, in fact, it is now 11 as the Waterford service commenced this week. They are located in Dublin north, Dublin south, Galway, the mid-west, covering Limerick, Clare and north Tipperary, Carlow-Kilkenny, Cork, Wicklow, Kildare, Louth and Meath, and as I said, Waterford commenced its service within the past week. I am not aware of a commitment to south Tipperary.