Dr. Brendan O'Shea:

The questions are really interesting and important ones and we would like to stay here all week to discuss them in detail. Senator Burke's question on where the funding should go is particularly important and we would concur fully with the observations of our colleagues. The big picture thinking is that, in this country, we spend approximately 2.5% of our budget in general practice in the primary care part of the system, while the NHS currently spends 8% and it is moving towards 11%. If the committee can advise the Oireachtas so that the Oireachtas makes correct decisions to effect that type of distribution, then we have the solutions.

The most important, effective and efficient part of the health system is arguably general practice. We are pleased and delighted that Deputy Murphy O'Mahony perceives the co-operatives as being highly efficient. They are efficient because they are run by general practitioners and are under the business umbrella, if one likes, of the independent contractor model.

Where should the money be spent? More of it should be spent in primary care, particularly in the general practice part of it. Another important question relates to where the diagnostics should be located. It takes six to nine months to get an MRI or an ultrasound. If we have standalones in primary care centres or hospitals delivering these services, as long as the access is equal to all citizens and efficient the Irish College of General Practitioners does not have a strong position on where the diagnostics should be located. How efficient should it be? Several years ago our colleagues in the Royal College of General Practitioners were appalled that it was taking more than six weeks to get a routine ultrasound so they decided that general practitioners should deliver ultrasound themselves. They engaged in training and now have a training programme and provide GP ultrasonography. This is part of what they are doing with their money and how they are using some of their 8%, as opposed to our struggling on the 2.5%. There are various solutions.

Dr. Hanley will take over now, but I wish to make one last observation. We all, including our colleagues in the HSE, have failed particularly the public patient in our industrial relations, IR, process over the past years. We sincerely hope that we are moving towards an ongoing consultative and evolving contract that is examined every 18 months and that never again will it it take 38 years to do it.