Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I was struck by a statement in one of the submissions to the effect that proposals to address the shortage of GPs by transferring tasks to other health care professionals are not in the interests of patients or the State and then it continued with a list of bad things that might happen.

That flies in the face of the evidence and reports we have heard about skill mix and it ties into the issue of allowances for the employment of practice staff, which is raised in another submission. I have a number of questions on that. We hear from GPs about how pressed they are for time. I can see in my constituency that the patients lists for the GP surgeries are long and they cannot accept additional patients. I would not dispute for a moment that GPs are under pressure. I do not think that making such statements about nurses is helpful but that is a matter for the GPs. Would it not make more sense therefore if some of the business element of that were to be removed in terms of the employment? I imagine it is difficult to be an employer. I am not and never wished to be an employer but one ends up in that position. Many of the GPs I have spoken to would almost refer to themselves as accidental employers. They want to be doctors. They want to work with their patients and do not necessarily wish be employers. Would it not make sense to get rid of the allowance, the fee per item and all the administration that goes with it and have practice nurses and staff that are directly employed by the HSE? I was examining the figures from the primary care reimbursement service, PCRS, which outline the number of procedures and the number of claims. For every procedure I can imagine a rainforest worth of forms that have to be filled out to claim back the money. I do not attend a GP regularly but I know much of the work in respect of the fee per item claims is done by practice nurses. If that element of the work was taken from the work of the surgery, it might free up GPs to do what they do best, and what they trained for, that is, the hands on care.

I apologise for having been obliged to step out for a meeting, so if my question on diagnostics has been asked already, I will be able to read the response in the transcripts. I know from the parliamentary questions I have tabled and from the experience in my constituency that the primary care centres will be housed in lovely buildings but no additional staff are being employed in them. If the witnesses could design an ideal fully functioning primary care centre and could staff it appropriately, what would be the staffing model? What therapies would be on offer? What ancillary and allied health professional staff would be available and how would it function in terms of the machinery and equipment? In terms of a fully functioning primary care centre, would equipment, such as scanners and near-patient testing and so on be required?

In regard to the community intervention teams, CITs, what is the GPs' relationship with them? I understand that some CITs operate as a separate stand-alone resource and some are integrated. Will the witnesses tell members how the system operates across the country? Members will know how it works in their area but the witnesses might be able to give us an understanding of their relationships with the CITs.

I raised the question of blood tests with the Minister for Health yesterday. I understand there are issues with blood tests and I would like to hear both sides of the argument. My understanding is that medical card patients should not have to pay for routine blood tests that are part of the diagnostics. Yet I have seen notices in doctors' surgeries advising patients that if they are not prepared to pay for their tests, they should be prepared to take themselves to the local hospital to have the test conducted. Perhaps members could be enlightened as to what is the issue with blood tests. Perhaps that is tied into the issue I raised earlier.