Dr. Brendan O'Shea:

This is a good question. We have had a high level of expertise come in and overview. One of our advisers, Dr. Paul Grundy, who is a global expert in health system design, said that there was a blank space in the regional space, that in our practices we actually do good work. At a national level we do good work now and we do good work in the college, but there is a vacuum in the regional space. We can populate that. The community health care organisations, CHOs, might be part of it if their terms and conditions are properly negotiated. GP co-operatives are bigger than the standard GP practice of two to four GPs, so there are 140 GPs. In my own co-operative in County Kildare, we have had a minor injuries service where we have really pushed suturing and have had access to out-of-hours trauma films. We can leave the study for members to read. GPs can do this, providing we can get away from being locked into face-time consulting.

The regionalisation vacuum significantly reflects the current General Medical Service, GMS, contract which has us handcuffed to 100% consulting all the time. To go back to the Veterans' Administration, if the new contract to be given to us allows any of us to spend 20% or 30% of our time not locked in face-to-face consulting, we can liaise with the pharmacist, we can go to primary care team meetings and we can talk. Carlow-Kilkenny has been built on the sweat of GPs and specialists who went to committee meetings and hammered it out. They got some bit of flexibility from their funding manager. The tragedy of Carlow-Kilkenny is that it is only Carlow-Kilkenny. In members' legislation and their recommendations, they should try to work in provisions in order that they do not impose a one-size-fits-all model. They must encompass the needs of rural GPs, and they must be able to support the-----