Dr. Brendan O'Shea:

We must have a rolling evolving contract. To return to an earlier point, we are not in the habit of having these conversations and we will just have to get good at it. It has to be an evolving contract. This is also a feature of more efficient health systems than ours.

To respond to Deputy O'Reilly's point, the blood test issue is very important. We have had a thousand difficult conversations with the patients in my small practice on this and it is utterly hateful. I was going to say the blood test is a symbol but it is about monitoring chronic disease. It is a matter of doing the test, making sure the results come back, communicating the results and perhaps altering the medication. Therefore, it is not just a blood test.

Dr. Austin Byrne's observation about the contract is correct. The contract we are operating is for the diagnosis of disease; not for the actual monitoring. It is really simple stuff.

An important issue that has popped up in two instances here is why general practitioners are not going into the primary care centres and there is also the matter of those doctors who are suddenly working much fewer sessions.