Dr. John O'Brien:

What can we do about it? It is pivotal that GPs are provided with sufficient time and resources to enable shared discussion on medicines management. We need to address the challenge of medicines reconciliation across health interfaces and promote electronic discharges to reduce error and improve quality. The role of clinical pharmacists in the general practice team or in a nursing home setting should be explored albeit as part of a new GP contract. Monitoring and audit of prescribing, if done correctly, has the potential to be an extremely powerful tool for GPs in their ongoing efforts to deliver the very best care for their patients.

Research and audit needs to be actively supported and promoted at the highest level. We need to be careful when comparing raw prescribing data from individuals with national standards. We need to take account of confounders such as poverty and deprivation or conditions such as multimorbidity and depression. Continuous medical education has seen a curtailment in funding in recent years and this needs to be reversed. Pharmaceutical advertising in the national media indirectly promoting certain products has been an unwelcome development in recent years. This should come under legislative control, as GPs are encountering demand for drugs and services which have dubious cost-benefit. This committee should endorse a recommendation for a ban on non-governmental health care advertising, especially the indirect promotion of drugs in the media.

GPs need time to deal with complex cases. This will require a modern GP contract that facilitates the management of chronic conditions and medication management. Before this, there is need for the urgent reversal of the financial emergency measures in the public interest, FEMPI, provisions, which have curtailed the ability of general practices to grow at a time when GP services should be expanding in the light of multimorbidity, ageing and increased numbers. We also need to retain our brightest and best GPs. Some 20% leave the country. They see other health care systems as a preferable career option. The ICGP is becoming increasingly frustrated with the lack of Government action on these key matters.

We need to direct any savings that we make in drug prescribing back into general practice to reinforce a cycle that is to the benefit of the patient and of the health system more widely. A medicines management programme, led by GPs, needs to be created as part of the new contract. The ICGP is willing to continue to work and collaborate with the HSE and educational bodies to promote cost-effective, evidence-based prescribing. Sometimes collaboration has not happened. An example would be online ratification for the issuing of certain drugs, which is time-consuming and often quite complicated. This has disenfranchised and increased frustration among GPs as they try to deliver care. Prescribing trends can only be identified through research and audit. Academic career structures for GPs have not been sufficiently facilitated by the HSE or the Department of Health.

Similarly, research on our electronic health records is underdeveloped in the Irish setting - I refer, for example, to the research done through the Irish Primary Care Research Network, which is run through the ICGP - and will require expansion and State funding in order to deliver savings in the future.