Dr. Ronan Fawsitt:

On Deputy Billy Kelleher's point, there is institutional resistance; there is resistance to change everywhere and we have reached tipping point on the issue. There is a need to change what is broken. Deputy Michael Harty is absolutely correct. He has nailed it in that the health service is broken and in a perilous place. We need to provide for continuity of care, of which general practice is the only provider. There are enablers that will allow greater GP participation, particularly in urban areas. We have discussed them with the primary care directorate. It will require a small amount of funding, but there is a willingness to do it. Unless the State supports this, we will stay in the bubble for another ten years when we will be back before the committee.

It is absolutely vital that we get the GP contract right. It is the future for my kids and grandkids. We have not had a model for a new health system in 44 years. Legislators should remember the year 1948, after Britain had been destroyed in two world wars and when it was bankrupt, but it still had the vision and political determination to put money into the National Health Service which no Briton would give up today.

The question was asked whether the GP or the team had priority.

It is a team, a multidisciplinary team. The GP is not above that. It is a team and everybody is equal. That is the Carlow-Kilkenny model. We need a more team-based approach in the community, but led by the GP who will be ultimately accountable for that care.

As regards where the diagnostics should go and whether they should be physically independent, I believe they should be. Hospitals should be doing specialist, high-tech work. I do not believe that we should be sending them low acuity stuff in diagnostics. We should be doing this in primary care resource centres. The new 80 primary care centres that are to be built in Ireland in the next two years should become resource centres for investigations and service hubs for physiotherapists, OT, IT and so forth. Counselling, something so simple and vital in mental health, should be provided in a primary care resource centre. All GPs in County Clare or County Kilkenny should have one or two of those resource centres where that is recognised. It is not a parallel structure because, in a way, those patients never get to the hospital. They will be treated and cared for much more cheaply in a primary care resource centre than in a hospital.

There are 80 sites coming on stream and this is a wonderful opportunity to get this right, but we must consult with our local GPs. If a local GP has spent €250,000 on a new premises, without tax relief or the like, why would they move to a primary care centre? It might look wonderful, but it makes no sense. One must work with the GPs on the ground. If they are not willing to move into a centre, that is fine. Let us work with the centres in a different way. However, they must become service and resource centres. That is the value and that is what keeps people at home.