Dr. David Gibney:

Somebody asked about practice nursing. We have been lucky in that we are in a really good building with four different practices. We pool resources, etc. I work with three GPs and our practice nurses look after the diabetic clinic. A link has been developed with Beaumont Hospital and the Mater Hospital and they come out once a month and see difficult patients for us. We have put in place a programme that works quite well. It is still very difficult but it works reasonably well. Our other practice nurse runs chronic obstructive pulmonary disease, COPD, clinics and asthma checks. She does all the smear tests and has become a prescribing nurse practitioner. She has just finished the course. There is a huge room and practice nurses have a huge role to play in the development of general practice in these areas. At the same time, it would be foolish to underestimate the need for oversight as well. A doctor must oversee it because problems arise. We work it together and it works quite well. There is definitely a role and it makes a huge difference when one does that.

I think the Deputy asked about community-based projects. One of the things having a proper primary care team has allowed us to do is to make links with the community. This is really important in deprived areas because communities are incredibly resourceful. They have developed a lot of resources in respect of the needs that have arisen in their communities. Our physiotherapist has a "back on track" programme whereby a patient with postural back ache can go to the physiotherapist in our centre. Our physiotherapist is particularly enthusiastic and has organised that the patient can go over to the local leisure centre and do a free six-week course with a trainer and the physiotherapist. The idea behind it is to demystify going to the gym and to encourage people to get involved. If they take part in that programme, there is a reduced membership fee for the first year. It is about using the resources we have in our area. We would always have been on the board of the youth action project and the drugs task force. They have funded an addiction counsellor who works in the practices one day a week so there is a linkage. That linkage between what is going on in the community and what we are doing in general practice has been really useful. Those things are really important in deprived areas because there is a wealth of experience in the community about what is going on and one can tap into it. However, it takes time.

We are talking about recruitment. We would all be GP trainers and the vast majority of people who train in our practices really like working in the areas they are in. How does someone set up with a list size that is not viable when they do not have premises? It is not possible do this in areas like ours. One needs infrastructure to attract people. It is not because people are not attracted to working in those areas. It is because it is not financially possible to do so.