Representatives from the Irish College of General Practitioners (ICGP) criticised the major lack of capacity in the service provision of mental healthcare, when attending the Oireachtas Joint Committee on the Future of Mental Healthcare to discuss medication and talk therapy.
They stated: “On a system wide basis, the volume of service provided by the Counselling in Primary Care Service (CIPC ) is inadequate, and a majority of the population are ineligible for CIPC services. The contribution of voluntary agencies is increasingly evident and important to GPs and people who use these services”.
The ICGP’s submission document highlighted the fact that, when well supported and adequately resourced, GP teams can engage systematically in activities known to prevent and care for a range of mental health issues and medical conditions, as usually the earliest diagnosis of severe spectrum or complex psychiatric diagnoses is undertaken by GPs.
The submission emphasised the fact that families are left to suffer when practices are being forced to practice in a dearth of resourcing, as time becomes a precious resource. Not only can less be done in terms of prevention and earlier intervention but more pressure is also placed on the shoulders of GPs to treat patients pharmacologically, or to refer them elsewhere.
FEMPI and the sustained failure to deliver a contract for general practice were underscored as having placed many professionally important activities in general practice under pressure, due to “competing and conflicting pressures of higher professional values set against relentless business pressures” and overall having acted as “impediments the delivery of essential community based mental healthcare for Irish citizens”.
Clear and honest communication around resourcing for mental healthcare was called for, in addition to increased capacity in GP-led healthcare within the Irish health system.
Three important issues in the current system that were brought to the attention of the Oireachtas Joint Committee included the low numbers of GPs and practice nurses per capita in the Irish health system (641 GPs per 100,000 population in Ireland, compared to 90-100 in Canada, Scotland and England), the low proportion of total health spending on primary care in Ireland, when compared to developed economies ( Canada, Australia, Scandinavian Health Systems and the UK), and the overall high per capita health spend on healthcare in Ireland (in the order of €22 billion) by international standards.
The ICGP commented: “Within the Irish health system, we are historically spending excessively on hospital based care, on administrative overheads, on technological medicine, on specialised care, and on pharmacological therapies, and that conversely, we are spending too little on primary care, and on holistic talking therapies”.
The college recommended that better and higher volumes of care could be provided by increasing capacity in GP-led care, adding that the recruitment and retention of more GPs would enable higher volumes and better quality of care in communities, including mental health, enabling better prevention, earlier diagnosis and better community based care.
Support was expressed for the Sláintecare Report, and for the recent HSE report ‘A Future Together’ , both of which underpin a ‘shift to the left’ in terms of a greater proportion of health spending in primary care, which would enable the embedding of greater volumes of allied health professional care, as well as a more rapid translation of new modalities and new technologies relevant to mental health care.
The Irish College of General Practitioners (ICGP) is the recognised body for the accreditation of specialist training in general practice in Ireland and is recognised by the Medical Council as the representative academic body for the specialty of general practice.
There are 3,724 members and associates in the college, comprising over 85 per cent of practising GPs in the Republic of Ireland, with 205 members in Northern Ireland, the United Kingdom, Canada and other overseas locations, and 690 GP trainees.