When I qualified as a GP in 1992, 60 percent of practices were single-handed, working mainly from converted premises with no practice nurses and entirely paper based. They provided largely reactive care with patients deciding when and why to visit.

Today’s GP graduates are entering a speciality providing a significant level of preventive and structured care, generally from multi-disciplinary group practices in purpose-built premises with sophisticated computer systems. In Turloughmore, Co Galway where I practise, we have been paperless for over a decade.

Health Research Board funding has been instrumental in transforming the landscape of general practice in Ireland, facilitating the development of more advanced and community-focused care models.

I can say this confidently, considering the multiple opportunities it gave me to collaborate on the production of evidence-based approaches to improving the accessibility and quality of primary care that now underpins national healthcare policy.

A Fundamental Question

As a researcher and practising GP, I have dedicated my career to answering a fundamental question: how can general practice best add years to patients’ lives and life to those years? A key part of the answer, I believe, lies in structured, evidence-based Chronic Disease Management (CDM).

Approximately 80% of GP consultations and 76% of hospital bed days are related to chronic disease and its complications. As a practising GP, I recognised the potential for general practice to provide cost-effective, high-quality care, so I embarked on a research journey over the past 25 years to enhance CDM through primary care.

One of the most pivotal moments in this journey was the 2002 HRB Programme Grant Award, which enabled the all-island SPHeRE Randomised Controlled Trial of cardiac secondary prevention in general practice. This study, the largest ever conducted in Irish general practice, demonstrated that structured GP-led care for cardiac patients reduced hospital admissions from 34% to 26%.

These findings were later reinforced by a systematic review in 2015, which provided conclusive evidence that secondary prevention of heart disease in primary care extends lives by at least six years. This body of work significantly contributed to the introduction in 2020 of Ireland’s

national CDM programme – of which secondary management of cardiac disease is a key component.

You are not alone

A lot of hard work went into establishing the evidence for these important innovations, but I am pleased to report that research is not a solitary endeavour. It thrives on collaboration.

I have been fortunate to work alongside outstanding colleagues, including Molly Byrne and Susan Smith, both since that first key SPHERE trial.

Over the years, my multidisciplinary collaborations with Edel Murphy, Margaret Cupples, Eamon O’Shea, John Newell and Paddy Gillespie, have further expanded our understanding of how structured interventions in primary care can drive better patient outcomes.

Aligning with patient need

A key lesson I have learned throughout my career is the importance of Public and Patient Involvement (PPI) in research. Initially, I underestimated its value. However, an encounter with a patient who participated in the SPHeRE trial was a turning point. While I was disappointed that the study did not show a reduction in mortality, she reminded me that quality of life – living better, not just longer – was what mattered most to her.

If we had incorporated PPI from the outset, our primary outcome measure might have been hospital admissions rather than mortality. Since then, every trial I have been involved in has incorporated PPI, ensuring that research priorities align with patient needs.

Despite the progress made, challenges remain for both patients and general practice – particularly in GP recruitment and retention. However, it is encouraging to see that GP training places have increased by 68% since 2020, with 350 trainees last year. Again, through a HRB Applied Partnership Award, we are currently studying GP emigration patterns. This investment in primary care capacity is essential to sustaining and expanding the benefits of structured CDM in primary care.

Research is key to continued innovation

Looking ahead, the future of general practice in Ireland and care in the community is closely tied to the continued integration of research into policy. The HRB’s commitment to funding high-quality, policy-relevant research has been transformative, demonstrating that evidence-based innovations in general practice can improve patient outcomes and system efficiency.

With sustained investment in research and collaboration, general practice will remain at the forefront of Ireland’s healthcare system, delivering even more accessible, effective, and patient-centred care.