Michael Harty (Clare, Independent)
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We are here today because there is an expectation that there is a pill for every ill. Patients have an expectation that is a cure for everything. It is very difficult to get that message across. Professor Fahey has a prescription with 14 items on it for a patient who has vitamin and iron deficiencies, probably has atrial fibrillation, has a pancreas deficiency, has chronic obstructive airways disease and is taking MST opiates for pain, something to counteract constipation and a PPI to protect the tummy against all of the other drugs he or she is taking. It is a very interesting prescription and learning tool.

When I have students with me, I often show them a prescription and ask them which two items they would remove from the list because they are unnecessary. As professionals, we can be drawn into the idea that there is a pill for every ill and, as a consequence, there can be a prescription with 14 items. If an elderly patient has a prescription with 14 items the likelihood of compliance is low unless the medication is blister-packed, and there are issues around that. Perhaps the witnesses might comment on the perception that there is a pill for every ill.

Reference was made in one of the opening statements to low value items having a high cost and how these are screened out in the context of medication reviews. In regard to general practice, general practitioners and geriatricians are probably the only generalists practising medicine now. As stated, to get a holistic picture of a patient general practitioners often have to distil down through prescriptions. I note Professor Fahey is smiling. I am sure he will have some comments to make on that issue.

In regard to Sláintecare, the report is with the Department of Health. We have not yet had a reaction to it. It is a radical report in that it proposes so many different changes to our health system, one of which is a transfer from hospital to general practice and community services, which are essential. It is important that we have a robust primary care service because the rest of the health service is built on sand. Perhaps the witnesses would like to extrapolate on that issue on the GP contract, which is a 24-7 and 365 day contract and on the concept of the doctor taking on all of the responsibility and paying for everything which is dead in the water.