Dr. Matthew Sadlier:

I will be as brief as possible. There were three basic issues so I will compact my replies rather than address them individually.

Regarding the question on primary care, since 2008 and FEMPI there are over 0.5 million extra GMS patients with medical cards than there were previously. General practitioner income has dropped by 23% under FEMPI. What we wish to emphasise is that GP income is not a personal income for the general practitioner. They are a sole practitioner running an infrastructure with overheads and premises. The difficulty is that, since I qualified ten years ago, we are in an era where patients have a higher level of expectation of chronic disease management and health screening, rather than the concept that one waits until one has a problem before first going to see the doctor. General practitioners are finding it increasingly difficult to make ends meet and to be able to provide proper chronic health screening and proper management for chronic illnesses. This is leading to services having to fall by the wayside if one cannot economically maintain them. As part of my presidency, we conducted a tour of the country and met practitioners in the different areas. They say they are obliged to let their primary care nurse or their practice nurse go or use the receptionist or drop the ability of the services they can provide to the community.

Second, there were two questions regarding the junior hospital doctors or the NCHDs. It is a very frustrating situation. I was a junior doctor or NCHD in Ireland for 13 years and during every one of those years the issue of hours was discussed. The fact that the NCHDs in Ireland, as a group of workers, had to resort to industrial action to have the legislation which was passed by the Oireachtas implemented for them is just bizarre in any shape or form. Yes, there is an ongoing process. I understand they are before the Labour Court today. The planned industrial action for yesterday was suspended. It is an ongoing process and talks are ongoing, so I cannot say any more than that.

Recruitment and retention is another significant issue. For one year post graduation medical graduates must remain as interns and the Medical Council said last year that less than 50% of interns had maintained their registration within Ireland after internship. The Irish health service has always depended on junior doctors or NCHDs to provide a vast amount of services. Since before I graduated we have campaigned to increase the number of specialists in the country so there can be a consultant provided service.