Professor Sean Tierney:

I thank the Deputy for his question. I may not be able to deal with all the specifics today because I have not come with all the information on it but I will respond in a general fashion. The IMO and all the GPs in the country are not at all happy that patients are being charged for blood tests. There are difficulties in providing that service. At its simplest, services that were provided by hospitals are being withdrawn with GPs having to take up considerable slack over the past years. We just heard about community services being displaced and the same is happening with the management of chronic disease. The situation is that de facto, patients who attended hospitals regularly for many different conditions are being discharged back to their GPs who have to take on a greater role in their day-to-day management. Given the number of times they attend the GP, the cost of providing services to them is increasing. Similarly, phlebotomy services are being withdrawn by hospitals with patients being told to go to their GPs for the blood tests. Within hospitals - my own is an example - patients coming to clinics are likely to be told the best thing for them is to go their GP to get their blood test done because they will have to wait a long time and because of the difficulty of having to return for results and so on.

Ultimately, the problem is we do not have a proper model of chronic illness care in the community which is organised, structured and funded. That is what needs to happen. We are willing, as an organisation, and GPs are more than eager to look at providing proper services in that regard and we have waited and offered to speak over the past number of years. We have not had a meeting about this issue so far in terms of the contractual implications.

GPs and doctors have been involved in clinical programmes and in identifying how chronic disease should be managed. How that will be delivered will require some negotiation around the GMS contract, which has not happened to date.