Dr. Ilona Duffy:

Deputy McLellan mentioned the check-ups. I suppose check-ups were one of the matters that were part of the contract for those aged under six. There is very little evidence to support the view that they will help. The big issue we must be careful of is that we do not end up filling up the time-slots and the face-to-face GP and patient time with box-ticking exercises. That, to an extent, is what has happened in the United Kingdom where one cannot be seen with a sore throat but one's baby will be seen in order to have its weight and length measured. We cannot let it happen there. We also have all of that work being done in the public health system through the public health nurses and through the public health doctors. At present, that is the least of our worries.

Bottlenecks, the congestion the Deputy mentioned and diagnostics are huge issues around the country. We are seeing difficulties in access to diagnostics. With simple diagnostics, such as ultrasound, where a general practitioner has somebody with tummy pain and wants to check whether the patient has gallstones, one cannot merely refer the patient in many areas of the country to get an ultrasound done. The patient must be referred to a surgical clinic. In many areas, the patient may wait nine to 12 months to get to that clinic when all he or she needs is an ultrasound for the general practitioner to make the diagnosis and then, appropriately, send the patient to see whether he or she needs surgery done. We are clogging up the system by not letting us have access to those systems.

As to why GPs are leaving, it is, as Dr. Walley stated, about stability and security. That is what they are not being provided with in Ireland at present. The impact of that is already hitting. I work in Monaghan where two GP practices have GP partners about to go on maternity leave - one in July and one in August. One of the practices is a two-doctor practice and that means it will lose a doctor. The other is a six-doctor practice and it will lose a doctor. They cannot find a doctor to do the maternity cover in those practices. Already, they are saying that they cannot tell the doctor she cannot take maternity leave. The doctors will go on maternity leave. What they will have to do is reduce access of service to patients. It will mean, especially in the case of the two-doctor practice, that they will be down to half-doctor time and that is not sustainable in the long term. This is the first time we are seeing this hitting home. Up until now, it has been that GPs merely have not taken holidays because they cannot get somebody to replace them but now, when we are seeing instances of maternity leave and sick leave, what is going to happen and where is that going to lead to?

I understand completely where Senator van Turnhout is coming from on out-of-hours cover and continuity, but, as Dr. Walley stated, we must get to a stage where it is safe for GPs to be working day time and night time, and we cannot have them doing both. My dad was a GP and I grew up with him working through the night, etc.