Dr. Brendan O'Shea:

The question on whether we are inputting into the process of contract negotiations is critical. Collectively, all of the stakeholders in the process have found entering negotiations, and doing so effectively for patients, has been historically very difficult. Certainly the college understands in detail what is required to be done and, therefore, this is very germane to the contract negotiations. Our information, knowledge and standards-based approach is available to the contract negotiation process. Conversely, we would see it as bad for the contract if we were locked out of it. This is the position of the Irish College of General Practitioners.

On the question of whether there is a model of diagnostics that works, the problem is that several models work quite well elsewhere. We must try not to fall down the fallacy of one size fits all. A very important question related to access to diagnostics and why blockages happen is whether it is because of competition between different professional groupings. We are not certain this is the case. However, we do see - in a funding model that is so focused on the acute hospital system, where budgets are so protected regarding the hospital - that our patients in the community are perennially at the bottom of the queue. It comes across in how budgets are disposed and managed by hospital-based managers who, regrettably, seem to view it on a short-term basis. There are also the practicalities of it. My local hospital does blood tests on an almost 24-hour basis but all of the samples in my practice must be taken between 9 a.m. and 11.30 a.m. on only four mornings each week because there is no blood collection on Fridays. Trying to manage chronic diseases with patients who need ongoing monitoring requires us to have them all in before 11.30 a.m. on four days each week.

That is an operational decision which reflects hospital priorities. One should not put oneself under significant pressure to get the contract right the first time. There is a need to build in reviews. This is a feature of the more effective systems that we have studied. People must determine what is working and what is not every 18 months. The Irish health system is paper based, so our data are usually two or three years behind. In general practice, we will deliver real-time data that will allow one to finesse the next round of contract negotiations. Historically, that process has been adversarial and competitive and has ignored the patient. We need to move to a truly collaborative system. If this committee can help us to do that, it will have done great work.