I welcome Dr. Donal Coffey and Dr. Gary Stack. I draw attention to the fact that while members of the committee have absolute privilege this privilege does not apply to witnesses appearing before the committee. Members have carefully studied the detailed presentation submitted by the delegation and we would be glad to have a brief synopsis of the position of the delegation. After that, we will bank questions from the members.
Killarney General Practitioners.
Dr. Gary Stack
Táimid an-bhuíoch as ucht bhur gcuireadh. Tá a fhios agaibh nach bhfuil sé de nós ag muintir Chiarraí teacht go dtí an phríomhchathair ag an am fuar seo den bhliain. Mar aon leis na peileadóirí, is fearr linn teacht go Áth Cliath sa samhradh. Dr. Coffey and I represent our Killarney colleagues who have been in discussion with the HSE since 2004. Prior to that we had earmarked a site but when we discussed the concept with the HSE it suggested that we move to the HSE site on the grounds of St. Finan's Hospital, as the HSE wished to have a significant involvement in our plans. From day one there was close involvement and liaison between the GPs and the HSE at local level in the design of every part of the building, focusing on integration of the primary care teams, with patient care as the linchpin.
The building is 110,000 sq. ft. and the investment is entirely and equally that of all 12 Killarney GPs. There are five practices at present in the town and they will continue to retain their individual identities within the building. Some 50% of the building will be leased to the HSE and 25% will be leased by the GPs. Of the remaining 25%, half will be in shell and core planning for the future and the other half is for additional ancillary services. Four primary care teams will be located in the building and part of the building will be a psychiatric day hospital, echoing the previous use of the site. We have secured permission from the NRA to construct a roundabout on the N22 to access the development.
The attraction for GPs in this project is providing services to our patients that we as individual practices are unable to deliver at present. By moving to one campus, we will be able to combine our resources and those of the HSE to provide the type of services that are not currently available in Killarney.
The concept combines GPs, health care professionals including the public health nurse, psychiatric community nurse, palliative care nurse, psychologist, social worker, physiotherapist and others, plus ancillary health care providers such as the dentist, pharmacist, chiropodist, optometrist, audiologist and so on. It is achieved by the primary care team integrating all the ancillary back-up services, each one synergistic and co-dependent on the other. The benefit for the patient is that all this happens under one roof.
Such a centre makes possible the development of many other new services that we are currently not able to provide as individual practices: dietetics, occupational therapy, prosthetics and visiting consultants. No longer should it be necessary for significant numbers of patients to travel daily to Tralee or Cork when they can be seen here in Killarney. It will now be possible to provide to patients investigative facilities such as x-ray, ultrasound, endoscopy and outpatient cardiac procedures. We are future proofing the building so that further services such as CT and MRI can be easily added.
Given the space limitations in Kerry General Hospital it is the HSE's wish that patients from Killarney and the wider south Kerry area who currently need to travel to outpatients in Tralee can have this service provided in the new centre. We are 20 miles from the nearest accident and emergency unit and have a large tourist population so we also plan to provide a minor injuries unit in the centre.
The centre will also house the current SouthDoc out of hours treatment centre. SouthDoc is the largest GP co-op in the country and was set up, with the help of the HSE, by Dr. Coffey and me. It covers all of Cork and Kerry and has a membership of 440 GPs, providing out of hours cover to all their patients plus the very substantial tourist population in the area.
The primary care centre is a major attraction for the third-level educational colleges in Munster. The recently opened medical school in the University of Limerick has requested that Killarney be one of its hub centres for undergraduate medical teaching. The UCC GP vocational training scheme, which trains future GPs, is looking to the GPs of Killarney to provide training places within each practice. The nursing school in the Institute of Technology in Tralee has requested placement for its student nurses. As CME tutor for Kerry for the past 18 years I would see our own out of hours ongoing medical education being undertaken in the centre, as recommended by the HSE, which recently took over its running from the post-graduate medical dental board.
While we already deliver a community based health care service to all patients, we now wish to do this in a more integrated manner with the HSE. In addition, we wish to make viable the provision of the many new services listed that we cannot currently provide as individual practices scattered about the town. As individual self-employed GPs we are already delivering a value for money service and we believe this model is an appropriate one to carry forward to this joint venture to the benefit of our patients.
This is a major investment for our members, in particular for those who are newly qualified. We have invested a substantial amount already and, having just secured planning permission, we request the committee's support and incentivisation for this project and others like it around the country. We firmly believe that it is in the best interest of patients and of Government that such projects are GP-led, designed and financed.
Tá muid go mór faoi chomaoin as ucht éiseacht a thabhairt dúinn.
That is the future of general practice, bringing services to the patient rather than patients trying to fit into a system. The presentation covered all the bases in which I am interested. When mentioning the word incentivisation, is there a feeling that tax incentives or capital are necessary to make this happen? Can it happen without those?
This seems to be a good model but it strikes me that the three towns, Killarney, Mallow and Roscrea, are of similar size. Dr. Stack mentioned that Dr. Coffey and he were involved in the establishment of SouthDoc. What kind of model would work in rural areas or in cities? This model works well in towns of a certain size where all the GPs can come together in one building but how would it work in areas with different populations? The doctors' experience in SouthDoc might assist in giving a view on that. Although the model works in some areas, there might be need for a different model in others.
I welcome the inclusion of psychiatry. One of the other groups mentioned that mental health services should be linked and such services should be seen as part of the general services available.
I thank the delegation for its presentation. Is funding available or how do the delegates see the project developing? What timeframe is envisaged? In its presentation Alpha Healthcare Limited indicated it was project manager for such a facility in Killarney. Is it the delegation's facility and, if not, are there two projects going ahead in Killarney?
I call Senator Coghlan. It is great to see Kerry Members present.
I travelled on the train this morning with one of the delegates. I very much welcome the delegation. As my friend and colleague, Deputy Reilly, said, this is the future of general practice. I declare an interest, as I come from Killarney. As one of the delegates knows well, I am the landlord of a pharmacy located beside one of the practices and I agree with them in trying to have all of the other services incorporated. I am not sure about the taking of pharmacies off the streets of our towns. Patients require the best of care and attention and none of us wants to go to hospital. To have services such as the taking of X-rays, an ultrasound, endoscopy, cardiac diagnostics and CT and MRI scans is wonderful. I wish the delegation well.
I add my voice to Deputy Reilly's comments. I do not know if committee members or people in general realise that the population of Killarney trebles and quadruples at peak times during the year. Being realistic, existing facilities cannot cope with this. As outlined in the presentation, the nearest accident and emergency department is 20 miles away; therefore, anybody with cuts or abrasions that need to be treated, or who needs to have X-rays taken, must go to Kerry General Hospital in Tralee. I support this initiative but have the same query as Deputy O'Hanlon with regard to Alpha Healthcare's proposals. Will there be one or two facilities? The delegates were the instigators of the SouthDoc service and are winners with a proven track record. It would be a big success for Killarney and the east Kerry area.
Dr. Donal Coffey
I shall deal with the issue of incentivisation first. The big danger with incentivisation and the provision of tax breaks is presented by corporatisation. If it could be limited to one practice, no GP group would have a problem with it. However, there would be a problem if incentivisation managed to include those involved in a development for profit. We are in this development to ensure the provision of services for patients, not profit — at least not in my lifetime.
With regard to funding, we do not know any more until we go to the banks. The indications are not great but we must put our case. We have just managed to receive planning permission. Alpha Healthcare is facilitator for our group; there is only one group in Killarney involved in developing a primary care centre — ours. We will make room for new GPs and if they wish to join, we will make it very easy for them. We are taking a punt on a large chunk of shell and core. It will not be a restrictive model but all-inclusive.
On mental health services——
I ask Dr. Coffey to return to the tax incentive issue. Perhaps other members are clear on it but I am not. Did he say one practice should be involved? I presume everybody will be involved in the process to some degree for profit.
Dr. Donal Coffey
Perhaps tax breaks should accrue to one development only.
Do you mean to one centre?
Dr. Donal Coffey
Yes, to one centre.
I think Dr. Coffey means that no professional can be involved in more than one centre and benefit by a tax break. That is what I have been saying.
Dr. Donal Coffey
That is correct.
Mental health services are dear to our hearts. Modern GPs wish to destigmatise the mental health services. Having these services in the general practice setting will help to do that.
The question of smaller towns was raised. In this process there was collaboration between us and the HSE to identify the needs of patients in the community and of the practices. That took an inordinate amount of time but I hope it will serve future projects by providing speedy solutions to their problems. One must cherry-pick what is suitable for smaller towns. Our project cannot be replicated all over the country. Each project must deal with the issues which present on the ground. This is how we rolled out SouthDoc. Different models are required in different parts of the country. Cork city if different from the Beara Peninsula or Killarney.
Dr. Coffey, yours will be a primary care network centre. As a major network, what engagement will you have with the teams in the smaller centres of population? What is your view on that question and do you have plans in that regard?
Dr. Gary Stack
The HSE had originally intended that there would be two separate buildings, an administrative building and a primary care centre. The HSE asked us to combine with an area for their administration. That is why our building is so large. People might be put off by the size of the building because a primary care centre would generally be much smaller. The building houses four primary care teams, three of which pertain to the town of Killarney and one to the GPs serving the hinterland. The project could be used as a model, divided by three or four, for a smaller town. Such a centre might not have the extra facilities, such as X-ray, which we hope to provide. The HSE is considering purchasing time in our investigative facilities to provide access for all patients rather than providing such facilities itself.
Senator Coghlan raised the issue of pharmacists. From the outset, we have kept pharmacists informed of what we are doing. We invited them to come on board and suggested various models to them. The SouthDoc model involved much communication with pharmacists. We are dealing with prescriptions which are issued on a once off basis. We are not in the centre of town, as Senator Coghlan said. More than 80% of prescriptions are repeat prescriptions. One does not go back to a doctor for a repeat prescription. One simply presents it at a pharmacy while getting the newspaper in the shop next door. The issue of taking pharmacists out of the centre of town has been greatly exaggerated.
Deputy O'Hanlon asked about the timeframe. Planning permission came through only last week. We now need to do detailed design and tendering. We expect construction to take approximately 18 months.
I think we are all happy on this side of the table. Thank you, Dr. Coffey and Dr. Stack, for your presentation. We congratulate you on your pioneering work in primary health care in County Kerry and wish you well with your project.
We will now go into private session.
I thank all the groups for attending and showing that there is energy to find a new way of delivering health care services. With the right sort of Government support, which I will support if given, we can change the face of primary care which is a big part of the problem in the health service.
The joint committee now faces the challenge of compiling a report which reflects the energy which undoubtedly there is in the sector.
The joint committee went into private session at 3.40 p.m. and adjourned at 3.50 p.m. until 3 p.m. on Tuesday, 10 March 2009.