Dr. Ronan Fawsitt:

I echo that. Why do we have mad waiting lists? We have 600,000 people waiting to see a specialist. Our population is less than 5 million so it is absolutely mad. A lot of those people on that waiting list could have services delivered in primary care. They do not need to see a specialist or the specialist needs to come to them. Of the beds occupied in acute hospitals, 40% are occupied by people with chronic disease; 55% of hospital costs are a result of chronic disease; and 80% of GP consults are for chronic disease. We are spending the money in the wrong place and in the wrong way and we need to shift a lot of that care for things such as COPD and heart failure. It needs to come out of the hospital, empires and silos and into general practice-led primary care teams. Many models around the world have developed the concept of a team. It is GP-led and includes a practice nurse, a nurse physician assistant and an administration person. In the US, they have shown that the primary care medical home model - which will not translate here although there are aspects of it that make sense - can reduce referrals, get better outcomes and better care, has lower costs and results in better satisfaction among providers. The biggest threat to providers is not money, it is about hope and a feeling that one's work as a junior doctor or nurse matters. We have had a lack of that hope for some time. The model of team-based care scaled for our practice population is the way forward. That is the international model that has worked. In the UK, 11% of GP practices have embraced that medical home model within two years and 14% of the NHS is now covered by a medical home model, which is team-based care involving people working to the top of their licence. It has reduced referrals to hospital, increased satisfaction among GPs and their staff and led to the retention of GPs in areas where GPS were falling off the cliff. An example is the Plymouth place we visited. In that practice, seven GPs were recruited whereas the neighbouring practices had begun to lose their partners. The concept of a GP-led team is very good for patients, GPs and hospitals. It would be good to the State as well because it will reduce costs and make health care systems sustainable.