Dr. Maev-Ann Wren:

I want to respond to Deputies O'Reilly and Kelleher's very pertinent questions about workforce planning. The model that the ESRI has developed was designed with a view to informing planning, including planning for capacity, staffing and spending when we develop the expenditure phase. In this country we tend to do these things as once-off exercises. We look at a particular specialty, a particular professional, and we look at demands at a moment in time. One of the things we need to be doing is repeatedly reiterating these exercises and updating them with the latest population projections. This brings us to the need to collect data routinely. One of the questions to which there are many answers is how many GPs there are in Ireland. This is not a routinely collected piece of administrative data. The HSE produces a personnel census every month for all the employees of the HSE, right across all of the programme areas, by grade and specialty, etc. General practice is developed within a private market and routine administrative data for general practice have not been collected.

In response to Deputy Kelleher's question about what policymakers can do, if we want to have primary care expansion, it would be of assistance if routine collection of data in this area were required. The comparison between health and education comes to mind when I reflect on what we might aim for. In education, we know in any given year what the pupil-teacher ratio will be and we know in any given school or area what the pupil-teacher ratio will be. It is not unreasonable to expect that we would in any given year know what the GP to population ratio or the GP to young children ratio will be in Fingal, for instance. That requires routine collection of data.

The ESRI has looked at the role of practice nurses in this report and in some of its other work. I concur with Dr. O'Dowd that the evidence shows that there is a great deal of scope for increasing the amount of care that is delivered by practice nurses in primary care in Ireland. In Northern Ireland, or indeed in the UK in general, the ratio of visits to nurses to visits to GPs is quite different. Much more care is delivered by nurses there. At a time when we are talking about primary care expansion and when there are concerns about the availability and supply of GPs, I suggest this is a really important part of the answer for Ireland.