Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

Section 5 outlines the contractual issues involved. There are a few to which I referred earlier.

In regard to GP practices, the emphasis in the 2001 primary care strategy document was on moving as many medical services as practical from the acute hospital setting to the primary care setting - GP surgeries and public health nurses - and providing care in the area where it was least complex at the least expense. That is the accepted norm and practice, both in the document and among the various professional bodies which represent the medical profession.

They would support that.

I raise this issue out of concern. We have previously referred to the pressure GPs are under, with rural GPs closing and urban GPs beginning to find things difficult. This legislation would throw into the mix many more consultations to be carried out under the GP contract for under-sixes. How does the Minister envisage moving the treatment of chronic illnesses from the acute hospital setting to the community setting? Although I do not expect the Minister of State to be able to answer this practical question now, has he considered this in terms of the development of primary care policy? If we are to treat diabetes, chronic obstructive pulmonary disease, COPD, arthritis and many other chronic illnesses in the GP surgery, there must be an acknowledgement that extra resources must be made available, because these illnesses are more complex than colds and flu. I am concerned that GPs might refer people to the acute hospital setting because they are under pressure in their surgeries around the country. Could the Minister expand on this? I do not expect him to give all the details today.

Last week at a committee meeting, Mr. Liam Doran of the Irish Nurses and Midwives Organisation, INMO, said many of his members were afraid to report issues.