Alan Kelly (Tipperary, Labour) | Oireachtas source

I thank the witnesses for coming before the committee. I am very much of the opinion we will have to move to salaried GP contracts. I read the opening statement and what the witnesses have said on this. There are a number of reasons for the move. We have gaps throughout the country. I have read what the witnesses stated on salaried GPs and independent contractors versus the corporate model. I am with them with regard to the corporate model so we can leave that aside. On the difference between salaried GPs and independent contractors - and I get the witnesses' point on investment in the community - will they indicate, in great detail, why they believe an independent contractor model would provide better value for money and why the services would be better than in a situation where GPs would be salaried. Do the witnesses accept that in some circumstances there will be a mixed model between salaried GPs and independent contractors because, simply put, in some parts of the country we will not have doctors otherwise? Do they think it is appropriate that we have salaried GPs throughout the country? How would we distinguish between how they would be paid and their facilities? Would there be certain conditioning based on the fact that some doctors would have to be put into rural areas where gaps exist?

The next issue relates to consultants, particularly those working in acute services in our hospitals. I am of the opinion that we will again be obliged to change our mode of action in this area and to directly employ consultants to work exclusively in the hospitals and exclusively for the public health service. We will have to grasp this nettle. We have issues in a range of specialties and I have no doubt - I accept the witnesses' point in this regard - that we do not have enough consultants in many disciplines. If, however, we are to have a ten-year plan for the health service we will have to pay consultants adequately to fill these gaps. Taking this for granted, would it be best to phase in, over a period, salaried consultants who would be paid by the taxpayer and who would work exclusively in the public health service? We will need this to ensure that we have a single-tier health service, which is for what the committee is aiming.

There is a feeling among many members of the public, and certainly public representatives, that there is not just a two-tier system regarding the health service, there is also such a system with regard to how certain consultants operate vis-à-vispublic and private patients.I have had much experience of that to which I refer to the point where I think that what is happening is, quite frankly, disgusting and unacceptable.