Professor Garry Courtney:

This is the real nub of the issue. At present, we have done it all for free. We met the GPs and said: "You are just admitting patients to hospital corridors. They are not really being well looked after. Will you give up that right and send them into an acute medical assessment unit?" They bought into that. It is more work for GPs and they did it for free. All of the diabetic patients are not seen in our hospital. The GPs see them for free. However, what did they get for that? One must give something and take something. They get a one week waiting list for a new diabetic. That is unheard of. As our diabetes doctors and nurses are not looking after all of those patients who are perfectly well managed in the community, totally stable and whom it is ridiculous to see in an acute hospital, we are able to see the acute ones. Why do we give them BNP, brain natriuretic peptide, tests? The hospital pays for the BNPs the GPs order, which is very expensive. Nobody else does that. However, if the BNP is high, we know that heart failure is developing. Dr. Fawsitt will write a letter saying he wants an echo. The echo is done and we do that for free. However, then he treats the patient. He does not admit the patient. Admitting the patients costs the earth.