Dr. Ronan Fawsitt:

To answer Deputy Madigan's question on the urban-rural divide, getting GPs to engage and getting everybody around the table is more challenging in urban areas, particularly in model 4 hospitals where a GP in north Dublin might be referring patients to two or three hospitals. What unifies them is the Irish College of General Practitioners and it has faculties. If we aligned the faculties with the hospitals, there would be a link. It is about connections. There is a solution but each area would be different. Our model might not translate fully to Wexford, Mullingar or Clare but parts of it will. It is the principle of the contact. Every area is different and they will come up with different solutions but this is the way forward.

I thank Deputy O'Connell for her questions. She asked about mental health, social care and psychiatry and we have that group at the table. They come to our liaison meeting. They attended the meeting last night. We have big issues with the child and adolescent mental health services, CAMHS. That group has also come to the table. It is more difficult to get those involved in providing those services to continue with the process. They have not continued with the process as fully as the other groups. Our strength is that everybody is at the table and if we need to bring somebody else in they will oblige. It is like this committee. If the Chairman invites somebody to attend, he or she will probably come because he or she will want to know what is happening.

Everybody is at the table. We are competing as regards access to diagnostics. We had a discussion about echoes last night. We want more echoes to be done at St. Luke's. Professor Courtney is running an excellent and huge oncology service at a new centre in St. Luke's. Cancer patients who are on certain treatments need seven echoes. Elderly and frail patients will die if they do not get the right medicine. They need echoes if they are to get the right medicine. We have had a number of robust discussions. It is not that there is not a willingness - it is that the resources are not available in the hospital system to give us what we need in the community. That is why we need to shift to more GP-led primary care. My colleague., Professor Courtney, might answer the question about complex patients.