Dr. John O'Brien:

A number of questions were raised and I suppose there is a common piece that perhaps ties many of them together. Some 40% of the funding of general practice has been taken out of the system. The first point that one must realise is that this has had consequences. GPs need time with people for a variety of reasons. The management of medication is only one of those reason, but there is also the management of their other problems, such as social and psychological problems. In order to provide time, one needs staff and staff cost money. This is linked to the issue that we are losing 20% of our GPs each year. They are choosing to go abroad. Their career opportunities are being impaired by what is taking place.

On the question of Versatis, it is worth noting that today there will be approximately 650 people on trolleys and some 500,000 people are waiting for appointments. Where do those people go for care? They actually end up in general practices and there is little in the line of immediate support in general practice for many of the conditions people have. We are talking about psychological therapies, physiotherapy and access to consultations with consultants, but those services are not available. The GPs are left in a predicament where they have to do something with the person who is in front of them who may be in pain. Not all of the 500,000 people who are on waiting lists are in pain, but some are. It ends up that medication is tried and if it is effective, that is great. Everybody has a pain tree, so one might start in the first instance by taking paracetamol and then one might take opioids.

Another is that one does not like to use non-steroidal anti-inflammatories in elderly people because of the impact on the kidneys. One might then wonder if there might be a neurogenic aspect to it or whether a Versatis patch might be a suitable way of prescribing in respect of a particular person. The Versatis patch is now much more difficult to get, so one finds oneself scratching around for other forms of nerve-blocking agents. As a result, one looks at anti-depressants, which are used but which tend to sedate. There is increased use of pregabalin, which has the brand name Lyrica and of which the members may have heard. It diverts prescribing into other areas. As a result, that issue arises again. The net problem is that there is not enough provision where it is necessary. It is necessary to bring the guns up to the front line. The front line is general practice. GPs deal with their patients in a holistic way and on a continuous basis. There is a whole iterative process that takes place and they are comprehensive, dealing with everything from people with diabetes to children with ear infections. If one is prepared to bring the assets to bear in the place of least expense and at the point of earliest contact, one is likely to have the best impact possible. If one does not do so, one is in trouble. We see the trolley numbers, the waiting times and the numbers on waiting lists, but what we cannot see is the contraction in the amount of time that GPs have to give to their patients, which is a major source of much of what the members are speaking about this morning.