Dr. Ray Walley:

The health care system that wins all the awards is the Dutch system. When they developed GP and community care, they took 30 years to do it. The funding of community care in Holland is 10% of the budget and the funding of general practice is also of the order of 10% of the budget. They did not do it over five years. Five years is incredibly ambitious in a system whereby the secondary care system is in paralysis. We are all about ambition but we want reality because ultimately general practice is left with the difficulties. Let us look at the figures. Many GPs face impending retirement and there is an ageing workforce. The average age of a general practitioner is of the order of 43 to 44 years of age. We have a workload problem. We need to prioritise things.

Deputy Louise O'Reilly inquired about industrial action. Industrial action is already happening. The ultimate industrial action is emigration. Younger GPs are not waiting to see what will happen because we have been listening to this for 12 or 13 years. Unless general practice and community care are funded now, it will cost even more money, but we have to get away from the peaks and troughs. We have had troughs of many billions taken out. Now we are at a peak. We are spending what we should spend but we are not necessarily replacing the money to ensure that we are dealing with the troughs for many years.

Getting back to Deputy Kelleher's question, when that happens, if one does not have appropriate funding, one has increased inappropriate prescribing. For example, the country with the lowest prescribing of antibiotics is Holland. One could ask why that is. It is because they have near-testing for C-reactive protein, CRP. We have looked for that. They have excellent daily, repeated access to blood tests. A person does not need to have it done in the surgery but he or she needs to access it somewhere. In the same way, it does not matter whether the X-ray is done in a hospital, in a surgery or a community care centre. As long as the machines are active all the time and being utilised in order that there are economies of scale, it does not matter where their location is. There is a higher incidence of antibiotic prescribing in some countries where there is not access to those tests. Ireland is at the lower level of antibiotic prescribing in the OECD but we need to improve on that. Last night I did a co-op shift. Three patients came in to me saying the only reason they were there was for an antibiotic. They were not interested in my opinion or an examination and none of the three satisfied the criteria for giving an antibiotic. As a result, I could not prescribe it. General practice and community care have to be funded to ensure we have effective health care going forward.