Seanad debates

Tuesday, 21 June 2016

2:30 pm

Photo of Keith SwanickKeith Swanick (Fianna Fail) | Oireachtas source

I welcome the Minister to the House to discuss important issues regarding the health system. As a GP based in rural Ireland, I would like to outline some of the issues in primary care, which is a crucial aspect of our health sector. I commend the Minister for his support of the ten-year consensus on health care. It is a hugely promising step for the Government, which will refocus discussions on health reform in this House and the Lower House on patient care rather than political gains.As a GP, I also commend the Minister for his recognition of the role of general practice. International studies demonstrate that the strength of a country's primary care system is associated with improved population health outcomes, regardless of per capitahealth spend and percentage of elderly patients. Furthermore, the World Health Organization, WHO, has reported that increased availability of primary health care is associated with higher patient satisfaction and reduced aggregate health care spending, and orientation towards a specialist-based system enforces inequality in access.

The time has come for all stakeholders to work together in a pragmatic and solution-driven approach to develop a ten-year plan to reform health care. I welcome Senator Colm Burke's comment regarding Senators being members of the ten-year committee. There is a need for better integration between primary and secondary care. This approach is supported by international evidence that it will deliver efficiency and better patient outcomes. Every €1 spent on primary care saves €5 elsewhere. This model works in Kilkenny, with the success of the local area integrated care committee and acute medical assessment unit. Kilkenny provides an example of what is possible for integration between primary and secondary care resulting in shorter patient waiting times, and giving GPs greater access to diagnostics. That will prevent the patient ending up in the wrong place at the wrong time. Patients often self-refer to accident and emergency departments, for example.

We have a current manpower crisis in general practice. A total of 157 GPs are trained per year, but we are currently exporting half of these highly-trained professionals. An Irish College of General Practitioners survey of trainees and newly qualified GPs in 2014 found that only 37.5% of GP trainees were definitely planning to stay and work in Ireland and only 43% saw themselves as a principal in a GP practice or partner in a group practice. An option for the remainder would be as employees in salaried posts. In the current climate, however, few existing practices have the finances to do this. While training more GPs is necessary, until an environment that will encourage those who are trained to stay is created, we cannot begin to solve this looming manpower crisis. A further concern is the ageing demographic of the current GP workforce. A report commissioned by the National Association of General Practitioners, NAGP, in 2015, by LHM Casey McGrath, found that more than 900 GPs - close to one third of the current workforce - expressed an intention to retire or emigrate in the following three to five years.

General practice currently carries out 22 million consultations per year with a greater than 95% satisfaction rating. This is expected to increase to 35 million annually in the next three to five years. The projected number of GPs needed to meet this demand is approximately 4,000. Currently, approximately 2,400 GPs have GMS contracts but with the projected retirements in the next few years, we stand to have only half the required numbers. However, we regularly hear from GPs who have emigrated to Australia, New Zealand and Canada. They consistently highlight that the major difference between our health care system and theirs is their timely access to diagnostics such as X-rays, scans, physiotherapy, counselling and expert opinion, the difference it makes to their working day and the benefit to their patients, which cannot be overestimated. In recent years, the State has rightly built primary care centres. However, this is not all about bricks and mortar. It is important that activity takes place within these centres to keep patients out of the secondary care system.

Ultimately, many of the challenges faced by GPs boil down to the terms and conditions of our working lives, which are dictated, as the Minister said, by an ancient contract between the State and the HSE. I hope he will confirm in due course that the NAGP will be invited to negotiate a new contract on behalf of its members. I believe he had constructive meeting with the association's representatives last week and I welcome his commitment to further engage with them in the coming weeks. The organisation has made significant gains in progressing key issues for GPs since its relaunch in 2013.

With regard to the Supplementary Estimate for health, Fianna Fáil welcomes the allocation of an additional €500 million with €40 million for home care services, €31 million for disabilities, €20 million ring-fenced for mental health services and €40 million for the new winter initiative. Should the Oireachtas health committee have extensive hearings with the Department and the HSE as to what is required to meet both the demographic demand and unmet need in order that all areas of proposed expenditure can be fully examined and scrutinised? In particular, the HSE should be invited to make a submission to the committee similar to that which was sent to the Department last August in order that health expenditure requirements can be extensively debated and analysed in advance of the budget in October.


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