Dr. John O'Brien:

I will respond to the question on medication, which is particularly topical just now. There was an article on it recently inThe Sunday Business Post, which I am sure everybody here has read. Essentially, the gist of that was that between 2006 and 2016 there was a two-to-three fold increase in the use of medication such as anti-depressants and sleep medications. This is a cause for concern but it must also be recognised that this is also a global trend. Across Europe there has been a 20% increase year-on-year in the use of these medications. It is worth pointing out that in that particular timeframe the population in this country increased by 500,000 people and there were an additional 500,000 people on medical cards. As everybody will be aware it was a very traumatic period for a lot of people in terms of unemployment, excessive personal debt and a public narrative of extreme pessimism and uncertainty. Like politicians, GPs see people day in, day out and we hear their stories. All this resulted in a great deal of anxiety and depression among people presenting to general practice. I am not making excuses; rather, I am putting a context on this.

Also, there have been very draconian cutbacks in health funding in this country, particularly in general practice. Funding to general practice is down 38%, which is an awful lot of resource to lose. Consequently, the net effect is that GPs have been attending more patients with fewer funds and a dearth of back up services because the hospitals services were also under considerable pressure. Consultation rates have increased and the times available to each patient have been constricted as a result. GPs have no desire to rely solely on medication and they do not do so but in circumstances where nothing is available they are sometimes forced into positions they would prefer were otherwise. This cannot be allowed to continue. It is bad for patients and it is a waste of public money. It is also demoralising for GPs. The provision of more GPs, more practice nurses and in-house counselling within general practice is badly needed.

The ICGP has worked on a number of projects with regard to reducing medication, including the reduction in benzodiazepine use, and up to 2012 had been able to demonstrate reductions in that regard but much of that reduction relates to legacy addictions which are very slow to respond to treatment and very hard to pull back. Also, as psychiatry prescribing passes through general practice it might look like the general practice is doing the prescribing but it is not because the general practitioner re-issues the psychiatry prescriptions. To that extent, some of what is happening is not in our control. Also, in tandem with the increase in the use of antidepressants across the Europe the suicide rate was falling.

There is not a right or a wrong answer to this question. There is no sweet point on which one can put one's finger, but such big increases would certainly be a cause for concern. Did Dr. O'Shea want to say something about this?