Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank the delegation for their attendance. Of all of the committees that I have sat on, this one has provided more solutions than I have ever heard in terms of any issue that we have tried to tackle. It is great to hear so many solutions. We must now work on how to implement the solutions and get them up and running. It is great to hear positive, concrete, direct, straightforward and logical solutions from GPs who work on the front line of health care.

My first question is on GP provision for children under six years of age. How have GPs working in disadvantaged areas reacted to the initiative? Has there been a significant increase in throughput? The initiative has lead to additional pressures but I would like to hear how the scheme has worked in disadvantaged areas? Have GPs working in disadvantaged areas had a different experience than other surgeries in terms of the initiative?

Can the delegation comment on the role of practice nurses? Earlier we heard an interesting take on a consultation with a patient called Catherine.

It strikes me that much of that could have been done by a practice nurse, as I am sure the witnesses will agree. How is the role of nurses in surgeries working out and how would Deep End Ireland like to see that enhanced and improved? I suspect it is a big part of the solution.

The issue of the shortage of GPs was addressed but I am not sure it was fully answered, although it may have been. The weighting of deprivation payments is an interesting concept and very worthy. I suspect that, in practice, it would be more possible in this area than in others. We tried this in the education area through the allocation of additional resources for children with special learning needs and there was an attempt to have a generic allocation model for all schools targeted at individual students from disadvantaged areas within each school. However, the schools had a big issue with collecting such data from parents and asking for information on who has what, and so on. Of course, in this case, the PCRS would have a lot of that data through the application process for the medical card, which applies to many people, so it makes it more possible.

We talked about referrals to hospitals. With regard to referrals to emergency departments in particular, is there a significant difference in areas of disadvantage? I want to hone in on unnecessary referrals to accident and emergency in that, as I understand it, anyone can call an ambulance, even with a pain in a toe, and the ambulance has to take the patient to the hospital's emergency unit, where they enter the triage system. There are hours of delay and the ambulance is held up at the hospital door and is not released, and all of that. What are the witnesses' comments on the issue of referrals to emergency departments?

With regard to diagnostics and X-rays, I had experience of the Spanish model of primary care when one of my children had an accident there on a bank holiday Saturday night. We could go to the local primary care centre where head injuries were ruled out, the wound was stitched and we were back in the apartment 15 minutes later. It that had happened at home in west Cork on a bank holiday Saturday night, I would have been in Cork University Hospital for hours, which is crazy. Will it ever be possible for X-rays to be introduced at primary care level and what is the critical mass of patients required, or will this always be kept in the hospital setting? I would be interested to know.