Dr. Brendan O'Shea:

An important feature of the new contract is that the current business model of general practice locks us into 100% consulting. The minute we stop consulting it creates a business risk for us in our practices. We would refer the committee to the Veterans' Administration model which has one GP, two practice nurses - one of whom has a technical slant and the other a clinical slant - and an administrator. That GP is enabled and encouraged to spend about 20% to 30% of his or her time outside of face-to-face consulting, so that he or she has time to go to multi-disciplinary meetings. The GP has time to engage in online consulting with specialists and telecommunications with his or her patients in nursing homes.

There are a whole lot of models that work. Our primary care strategy from 15 years ago would have worked quite well but I am going back to it. One has to legislate and there must be a contract to enable us to engage effectively. We are not engaging because we do not want to; it is because our business model has us absolutely strapped to full-time consulting. If the committee can address that, it will do us and our patients a great service. If a new contract is devised, it will not be perfect, so it will have to be reviewed in 18 months. The last contract was devised in 1988.