Dr. Brendan O'Shea:

Deputy Harty mentioned Sláintecare and the key points coming from it. In key respects, the ICGP is very supportive of the approach taken by Sláintecare.

We would welcome a shift of care and treatment into communities and community-based services.

On the issues raised by Senator Murnane O'Connor relating to the system of referrals and gating people into age categories, that is, in its totality, care rationing. We feel the greatest and most obvious way to address that is to increase capacity in general medical care so that more can be done at a lower level of cost and complexity so that the right care is provided by the right person at the right time. If enough practice nurses and general practitioners, GPs, are evident, that is the space in which much of that care can be delivered.

We have to be strategic because we cannot do everything and cannot act on all the suggestions. It is the view of the Irish College of General Practitioners, ICGP, that a really important suggestion to act on is this issue of capacity in GP-led primary care. It will solve a greater proportion of most of the problems. If one has the manpower on the ground, one will be able to co-ordinate and signpost issues.

There was a question on gatekeeping. Gatekeeping is critically important for the health system but it is not a politically attractive word. Signposting and care co-ordination are also issues. Care co-ordination is a key skill set of general practitioners and practice nurses. If one has more general practitioners and practice nurses, it is more likely that one will have the co-ordination one is looking for.