Dr. Brian Osborne:

GP access to diagnostic facilities is crucial. Consider the circumstances when patients present at an early, undifferentiated stage of illness, often with vague symptoms. If we do not have access to diagnostic facilities, it is very difficult to diagnose anything.

At the back of the circulated pack, there are results of a study produced earlier this year by the Irish Cancer Society and Irish College of General Practitioners earlier this year. It compares the effects of access to diagnostic facilities in the public and private systems. Currently, the waiting periods for chest X-rays are quite similar, at a day or two. For a private ultrasound scan, there is a five-day waiting list. For a public ultrasound scan, there is an 80-day waiting list. For a CT scan of the brain, chest or abdomen, a private patient must wait for less than a week while a public patient must wait up to 55 days. Accessing an MRI scan privately takes from five to six days. Accessing an MRI brain scan in the public system takes 125 days. In any civilised, decent, fair society, this cannot be right.

With regard to who has access, 20% of GPs do not even have access to ultrasound facilities. Some 80% do not have access to CT and 90% do not have access to MRI. Without access to diagnostic facilities, we are left out in the cold.

On the question of whether there should be separate approaches, there should be a ring-fenced budget. The college feels there should be a ring-fenced budget, most likely associated with a separate centre. Thus, if a GP requests an investigation, it will not be put to the back of the system if an emergency patient walks in. There should be a separate budget for each case.

I have referred to one diagnostic type. There is a blood test that can diagnose heart failure called the B-type natriuretic peptide, BNP, test. Professor Ken McDonald, the HSE's clinical lead for the heart failure programme, has shown that heart failure costs Irish society €660 million per annum, with a direct cost to the HSE of €147 million. BNP is a test that can diagnose heart failure quickly. Where GPs have had rapid access, there has been a 30% reduction in the need for echocardiography and a 60% reduction in the need for a consultant review. This ties in with other studies showing that only 30% to 40% of patients who go to heart failure clinics are actually diagnosed with heart failure. This is because it can be very difficult to differentiate between heart failure and COPD, frailty or other illnesses.

I will outline exactly what heart failure is and what it does to patients. It causes chronic fatigue, shortness of breath and anxiety. People feel like they are drowning in their own fluids. A six-month delay in diagnosis of heart failure leads to a 23% increase in unscheduled hospital admissions, with all their attendant costs.

At the back of the documentation circulated, there is a map that shows GP access to BNP testing throughout the country. Those in the green category have access while those in the red category do not. Over half of the GPs in the country do not have access to BNP testing for their patients, which leads to increased costs and worse outcomes.