Dr. Colin Doherty:

I thank the members for their questions and I will try to address them as specifically as I can. With regard to managed primary care and how it will be delivered and why it may not be very advanced, it goes back to what Professor Hardiman stated. What patients seek, particularly when they are diagnosed with a chronic disease, is a pathway of care. They do not just seek one specialist. We know from chronic diseases unless we can use all of the resources the health services have to bear, including community services of which primary care doctors are leaders and engage them in delivering some of the care, we will be overwhelmed. Academically everyone agrees with this.

Our nurses are in place everywhere except the south. They are available and willing to deliver care. We are engaging with the primary care nurses with an e-learning programme to teach them how to deliver care. We believe 70% of patients with epilepsy can be managed safely in the community. Our real problem is a contractual issue. It is not an issue of privilege and no one needs to be here to answer it. A new contract is being negotiated which will, we hope, deliver a clear remit for primary care to deal with chronic disease. At present it does not exist. The letter of the existing contract does not state there is an absolute role to deliver chronic disease management. Until this is fixed we will not be able to get this moving in a widespread fashion.