Dr. Brendan O'Shea:

These are very important issues and are very charged. We all have very significant performance anxiety over getting this right. There are several ways to go about it but we know, from examples in other systems which have carried out effective reform, that consultation is the way to go. However, our health system does not have that habit. We will probably not get it all right and we will get bits of it wrong. It is very important that the last paragraph of the contact stipulates that the contract will be reviewed again, not in 38 months but in 18 months. We need to think German, that is, we must have constant negotiation among all the partners including the most important, which is not the general practitioner, nor the pharmacist, nor the practice nurse, nor the administrator but the patient.