Professor Garry Courtney:

I can only speak about our hospital. I do not have an estimate for that. We have a very forward-looking endocrinologist in our hospital who looks outside the hospital and almost all diabetic care is delivered in the community, so that is close to the 5% figure that was mentioned. He only sees new diabetics, GPs follow up on them and we have diabetic nurses that work across the hospital and the community. Chronic obstructive pulmonary disease, COPD, is the next biggest disaster for the health service and we are managing patients with that condition with nurses employed by the hospital who work in the community. I would love to provide pulmonary rehabilitation in the community but because we do not have the space, we do that in the hospital. Hospital doctors do not see those patients, they are seen by a physiotherapist and a nurse. We treat patients with heart failure through virtual care in a linkage between GPs and Professor Ken McDonald at St. Vincent's Hospital. Kilkenny is a bad example to use in this respect because we push the care of all those chronic disease cases out into the community. If I had to guess - and it is a guess - we probably treat 75% of cases in the community, which is fantastic. The figure for the remainder of the country might be 50% or less.

I will tell the committee something that I find maddening. GPs in our hospital are allowed total access to blood tests, BNP tests, and ultrasound results. At our meeting last night we discussed the inclusion of echoes. The HSE is catching on and it will now allow GPs to purchase ultrasounds and they will pay for them. However, our hospital has been bearing that cost. We are delighted about this. We have done a study and it shows that a GP who has been qualified for 20 years knows more about ordering an ultrasound than a junior doctor who has only been qualified for 20 months. There is a perverse incentive there. The hospitals that do not allow GPs ultrasound access will be paid for that and my hospital, which has been allowing GPs such access for years, does not get paid. That is annoying.