General practitioners' conference: In a document published at the weekend, the Irish College of General Practitioners (ICGP) has criticised the Government for failing to include general practice in its reform programme for the health sector.
"Healthcare Reform: The ICGP response" says 90 per cent of healthcare needs are met in primary care, and that healthcare expenditure is more than halved when care is initiated by the patient's family doctor.
In a response to the National Task Force on Medical Staffing (Hanly) report, the ICGP said: "This task force did not address the question of general practice manpower. Therefore the total medical specialist requirements of the health system have not been identified.
"An incorrect balance in the numbers of hospital consultants and GPs per head of population may result in a specialist/hos-pital-centred health system, with increased costs but without equality and population health benefits."
The representative body for general practice in the Republic also said it was concerned that Hanly included no reference to the impact of the doubling of consultant numbers on private practice.
"In other jurisdictions, underemployed specialists seeking to supplement their income have done so by abandoning the referral system and providing direct access for patients. This soon becomes a partial fragmented form of primary care."
The outgoing chairman of the ICGP, Dr Richard Brennan, said that research on the impact of primary care on 12 European and North American countries showed that countries with more highly-developed systems of primary care tend to have "lower costs, lower mortality rates, longer life expectancy and greater satisfaction with their healthcare system".
Outlining the barriers to reform of general practice and primary care here, the document notes a lack of "political will to challenge and change the old order, prioritise primary-care development and to commit the required resources".
It lists other factors inhibiting reform as: manpower shortages linked to increasing workload; a shortage of other key primary-care team members; and the lack of integrated protocols to improve the management of chronic diseases.
It highlights the particular barriers at the interface between general practice and hospitals as "poor communications, restricted access to laboratory and X-ray services, dysfunctional accident and emergency departments and problems with admission and discharge policies".
The ICGP says general practice can contribute to healthcare quality and value by addressing drug costs, in particular by the drug-budgeting initiatives and by developing a counterbalance to pharmaceutical marketing.