Dr. Ilona Duffy:

We provide the out-of-hours cover. The position has improved. The big improvement with the out-of-hours services being more organised now is that it is GPs providing the service. It is not merely locum agencies, where it is hospital doctors or doctors flying in from abroad to do weekend sessions, which is what is happening in the United Kingdom. In the United Kingdom, one does not know whether one is seeing a GP; one is seeing a doctor. There is a huge difference between a parent with a sick child seeing a doctor who specialises in obstetrics and gynaecology, and them seeing a GP who recognises a sore throat and realises the child does not need to be admitted for intravenous antibiotics.

It is important that we develop and protect the out-of-hours cover. However, we are struggling with that. As the day-time work becomes busier and GPs are having to work longer and later, they are not in a position to do as many shifts. We are struggling with that.

Dr. Walley covered infrastructure. On the 97% satisfaction rate, one of the big reasons we have that is we provide choice. One can choose who one's GP is here. If one lives in the United Kingdom, one does not have that same choice; one is allocated to a practice. I have a sister and a brother who have been in the United Kingdom and my sister was four months on a waiting list to get a GP practice. She was told the practice she must join, which was in her catchment area. However, they said that they did not have space on it yet and they would let her know when they do. Any time she got sick, she was told to go to accident and emergency. We do not want that to happen here. This is a big issue, be it one person with a medical card or a private patient. Patients must have the ability to move around and choose a GP who is to one's liking and with whom one gets on.

Senator Colm Burke raised the cost of health care and the medication. Professor Michael Barry, who is professor of pharmacoeconomics in Trinity, has been working on the preferred drug prescribing scheme with the HSE. One of his tasks has been to go around the country. One of my roles is in medical education for the GPs, as Dr. Walley mentioned already. Professor Barry has been all over the country meeting GPs, talking about this and asking how can we get drug costs down. It is clear that we have a finite budget. We are aware of that. New developments and new medication are always more expensive. If we can save money in medications that are coming off patent and will become generic drugs, that is all to our benefit because it will mean we can have more drugs for the cancer patients, MS patients, etc. The difficult is, as the Senator stated, that prices have been arranged, and that needs to be looked at. Why can one go to Spain and get six months' supply of medication for the same cost as a month's here? Why can my patients in Monaghan ask me to give them a prescription so that they can go across the Border rather than buying it here? That needs to be addressed. However, GPs are wholeheartedly engaging in that and have been meeting with Professor Barry to look at it throughout the country.

Hospitals must become responsible with prescribing. We all are fully aware that there is one particular stomach tablet that is prescribed by most of the hospitals, and there are reasons for that. However, that means every time one refers a patient he or she comes home with one brand of medication only. It is difficult for us in the community to try breaking that, yet it has cost implications.

Finally, in response to Deputy Neville, mental health takes time. We are the first port of call for many patients. We conducted a study in our practice to look at how many patients who were on antidepressants were attending psychiatry as well and 80% of those on antidepressants in our practice only see us. We are managing them. One of the reasons that has improved for us, and why we are able to hold on to those patients and look after them, was the introduction of primary care access to psychology services.

Something that started out as a fantastic resource for us, now has a waiting list of 15 months. That is happening because of cuts and moratoriums on the hiring or rehiring of staff who are on leave, including sick leave. We now find that we cannot get access to those services which we know will work to help the patient and also help us to manage them in a primary care setting.