Dr. Alison Dougall:

I provide care for a population with haemophilia. Ten years ago they would have all travelled to Dublin for all of their dental care. This led to waiting lists and decreased access. People who had difficulty travelling needed to come from counties Mayo and Roscommon. Over a period of four years, both by training primary care practitioners and offering shared care, where people can receive their preventive, minimal invasive care near their homes regularly, a saving of €2.5 million for factor usage for dentistry in a two-year period was achieved. Economics is not the driver. It also showed increased access to care and less invasive surgery. The price of having to provide complex care in a secondary stage, whether it is general anaesthetic or an integrated medical model in a tertiary or secondary care unit, is significant.

There is an ability to prevent, by working with networks of well-supported, well-trained primary care professionals in the HSE clinics or in general practice, as the patient prefers. Patients have to have choice. The greatest thing about this policy is giving choice to people as to where they take their preventive packages. That has been a big factor with patients. They want a choice and to be able to attend the same practitioner, if possible, as their families, and not to be medicalised.

There is choice but economics also is a really big factor. We can show that in many models with medically complex patients.