Dr. Brendan O'Shea:

It must all depend on real-time, measured performance. Different combinations could actually work quite well. Historically, our experience with a hospital has been so difficult that we are actually disenchanted with it. Therefore, many of us feel the facilities should be taken out of the hospital setting and put in stand-alone facilities. There are examples in various general practices. I refer to bigger practices. In my own co-operative, KDOC, we have a radiology department on site. We are not that fussy about where diagnostic facilities are located but they must be made available to the complex comorbid patient quickly.

The concept of salaried GPs could possibly work. However, our history with the HSE and the Department of Health regarding salaried colleagues is quite poor.

We would refer the committee to what has happened with salaried doctors in the secondary hospital system. Historically, year after year, doctors have been taken out of the Sudan, India and Pakistan to prop up our hospital system. These are salaried doctors. We do not want that coming into primary care, not because we have any difficulty with the doctors concerned but because when one takes doctors out of the Sudan, Pakistan and India, one is killing people in those villages.