Sláintecare and general practice

 

Sir, – The Sláintecare report takes as its starting point that the healthcare system is iniquitous and overloaded, and it is hard to argue with that. To address this, it proposes a reordering of what happens in hospital care and a transfer to the community of that which would be managed more efficiently and cheaply there.

General practice is the principal player in the primary care domain but receives less than 4 per cent of the national health spend compared to 8 per cent in the UK; it is understaffed, overburdened and under-resourced. We are running out of enough GPs and this is set to worsen as they are an ageing group. Using HSE projections in the medical workforce planning report 2015, it is estimated we will be short a further 700 GPs in seven years.

Sláintecare cannot come to pass without a robust and expanding general practice, but actually we are travelling in the opposite direction. We spend as much and more on healthcare as other OECD countries but we spend it in the wrong places.

General practice is usually the location where medical problems are first dealt with: to resource it, staff it and support it – so that problems need progress no further – appears an obvious strategy, but the spending figures reveal the reverse is happening. Year on year, we spend more and more on the health service, but it is not going into general practice or primary care, so more and more work is shifting to expensive hospital care.

The solution is hiding in plain sight: divest resources from other areas and transfer them into general practice and other primary care services. This is politically painful and will need transitional funding but if matters are left as they are, the ongoing escalation of costs so rightly alluded to will continue.

Furthermore, the sequencing of spending in primary care matters. It is true that primary care centres are part of the solution but a new shiny building never treated a patient. General practice is very short of staff, is short of resources and is attempting to deliver on threadbare budgets. The idea that it is in a position to take on more work without repair and real support is delusional. – Yours, etc,

Dr JOHN O’BRIEN,

President,

Irish College

of General Practitioners,

Dublin 2.