The chairman of the Irish College of General Practitioners, Dr Brian Coffey, has urged greater patient involvement in the debate about the future of general practice.
Speaking at the ICGP annual meeting in Westport where a joint Irish Medical Organisation-ICGP policy statement was launched, Dr Coffey said it was a time of great opportunity for both doctors and patients.
He later told The Irish Times that, from a patient's perspective, the concept of universal patient registration (UPR) - a key recommendation in the policy statement - offered considerable benefits.
Under UPR, every person in the State would choose a particular GP to provide comprehensive medical care, including preventive services. The proposal is still at the development stage, and although the need for it has been recognised by the Department of Health, there is no commitment to introduce it.
Dr Coffey said that under UPR, "there will be a more formalised contract of care between doctor and patient which will facilitate preventive medicine. For example, within the national cardiovascular strategy, we could legitimately ask patients to attend for screening for heart disease with UPR in place."
Dr Tony O'Sullivan, of the patients' representative group, Patient Focus, said patients would be positive about UPR because they wanted healthcare to be integrated. "As long as patients feel in charge of information about their health, there will be no resistance to the registration process at GP level," he predicted.
General practitioners attending the conference reacted positively to the overall thrust of the new policy, A Vision of General Practice Priorities 2001-2006.
Referring to the document's manpower statement Dr Velma Harkins called for "at least a doubling in the number of GPs" if the crisis in primary care was to be addressed.
Dr James Reilly called for a reduction in doctors' working hours incorporating a "9-5" basic contract with separate and optional out-of-hours commitment.
Asked by The Irish Times if the working group had addressed the issue of optimal patient list size, Dr Michael Boland, a co-author of the document, said the average list size would fall. "The implication of an increased range of services in general practice is that a greater number of GPs will be seeing a smaller number of patients."
Dr Roddy Quinn said GPs could not care effectively for the number of patients they were expected to look after at the present time. "It is essential we define the number of patients we will be looking after in the new scheme of things."
Referring to the practical implications of the new policy statement, Dr John Madden, president of the ICGP, said: "If we do not know what our patient population is, then GPs cannot work at optimum efficiency in terms of prevention and screening. At the end of the day we have got to move towards a GP service that the country needs and deserves".
The document has been launched at a time when the Government is preparing a new health strategy and the health boards have completed a major review of general practice. All stakeholders recognise that the 30-year-old General Medical Services Scheme needs to be replaced.
There is also an acknowledgement that the present two-tier system is inequitable and is not capable of delivering preventive medical care.
Dr Boland received sustained applause when he said the State was spending increasing amounts of money on the wrong kind of healthcare. There was a poor return on investment in the secondary and tertiary sectors, he added, with no evidence of a reduction in waiting lists despite the appointment of more specialists.
Acknowledging the need for a partnership approach, the document states: "We believe that the policies outlined in this joint statement provide a solid basis for discussion and development between general practice, the health boards and the Department of Health and Children and that the ultimate outcome will impact significantly on the quality of healthcare generally and that delivered by general practitioners in particular."