Professor Garry Courtney:

I wish to add to the comments about funding. Ours is the 11th busiest hospital in the State and we have the 18th largest funding. Therefore, we are relatively underfunded. As a result of that, we work differently. If a GP in north Dublin sends a patient to the emergency department, ED, the his or her letter is ignored. Why would a patient in north Dublin go to see a GP? It does not do them any good. If a GP in Carlow or Kilkenny sees a patient and writes a letter, the patient goes to the top of the queue. The patient is registered in the ED - we call it an acute floor now - and goes straight to where the GP asked him or her to go. There is no middleman, no nurse triage and no quick look by an experienced ED doctor. The patient goes straight to where the GP asked him or her to go. If the GP wants the patient to receive medicine, he or she goes to the acute medical assessment unit. If the GP wants the patient to go to psychiatry, he or she goes to acute psychiatry assessment. If the GP wants the patient to go to paediatrics, he or she goes to paediatrics. It is not always right, but there is an astonishingly low number of errors occurring, perhaps one per week. We have 45,000 ED attendances per year, which is almost the same as St. Vincent's Hospital. The GP has absolute primacy.