Professor Tom O'Dowd:

Let us deal with the money end of it. There is no doubt about it. People see the health budget as a fairly sealed entity. I believe we have to look at transferring funds. In providing long-term illness and improved diagnostic services, practice-based staff and information technology all require funding. Some of this would be once-off funding. IT funding is very much once-off funding, as is funding for diagnostic services especially for equipment. The equipment has fallen in price. The other side relates to primary care as structured. I listened to Dr. Wren's statement. As general practice is structured now, it simply would be unable to cope with that workload. It is only hanging in there at the moment. I would be misleading committee members if I did not highlight that it is no more than hanging in there at the moment.

Transitional funding could be spread over several years. It needs to be strengthened to international standards. There are quick wins. We studied the situation in Vermont, where they transitioned the system from a hospital-based system to a system based far more on primary care. Those involved reduced the spend on health, often by providing allied health professionals, having some transitional funding, and it gave them considerable longer-term gains.

At this stage of my career, it is frustrating to see that many of the pieces are available but not joined up. This is frustrating in our system. We have very good people working in the system but they are not joined up. This includes, at my end of the profession, a well-trained cohort of GPs and an entrepreneurial GP workforce. The medical profession can be snide about entrepreneurship but it is important. If we want to keep a general practice system going on 4.5% of the health budget, then we need a lot of business smarts to keep it going. Premises have to be modernised. The Chairman, Deputy Harty, and I will remember the time when a GP bought the garage in a corner house to set up a practice. Those days are long gone. We have an active college of general practitioners with a large membership and we have a referral system that works through the efforts of the Medical Council. There was a time, when I went into practice, when patients could refer themselves directly into secondary care and never see a GP. That has gone so the gatekeeper effect is far more important. All our doctors are registered and indemnified.

The evidence supports a decisive shift to primary care. This is central to the transformation of the health services. I believe there is an unusual consensus now among politicians, including those present, who are leaders in our State, policy makers and clinicians that this is the way to go. Although it is the way to go, it will not be easy. We are a conservative country. Our patients do not like change. Our system does not like that change. It will require much courage and leadership to make it happen.

At the moment we need a shift from an institutional and inappropriate and expensive method of care. Our private health insurers have not played a role. They have a distorting effect on health care in Ireland. They are hiding in plain view. The income for a GMS patient for a GP is approximately €280 per year.

For a private patient, it is approximately €116. This private practice has leached into private clinics that are funded or reimbursed by private health insurers and this is having a distorting affect on the provision of health care. This is a legitimate area of concern for legislators. Moving from the current system we have to a primary care led system will be a philosophical, political and financial journey. I do not know anybody who is against it, but I think it requires political leadership at this stage.