Dr. Ronan Fawsitt:

I thank Deputy O'Reilly for those questions. On the diagnostics issue, if we centralise diagnostics in a primary care centre and very few GPs have access to it, the pathway will shut down and it will not get traction. We have proposed that existing primary care centres and the new 80 or so that are being built should become primary care resource centres. Such a centre might not necessarily have a GP in the room or in the building but all GPs in the relevant area would refer their ultrasounds, echoes, etc., through that centre, thereby creating traction. Believe me, the machine at the centre in question would then be used. Why would I send my patients to Professor Courtney for an ultrasound when I can get it done quicker at a primary care resource centre down the road? Probably the same radiologist would read it because we will have to enter into contracted arrangements for high-quality radiology services with the relevant professionals. This is what is known as joined-up thinking. Having primary care resources centres is a way of maximising usage of primary care centres.

There will always be that 5% of patients requiring chronic disease management. I do not generally look after insulin-dependent diabetics because they need something more than me. In Carlow-Kilkenny we fit more pumps for children than anywhere else nationally. We have no waiting list for new diabetics in Carlow-Kilkenny because the service is run by clinical nurse specialists in co-operation with the GPs. If I need a person who has been newly diagnosed with diabetes to see a consultant, that will happen. If we put the care and resources in the right place, we will free up the hospitals.