Dr. Brendan O'Shea:

I would strongly concur with my colleague, as I always do. There is no doubt, from the perspective of the ICGP, that members of the college do have the necessary skills. A question mark lies over our total capacity, but as I said earlier, this does not particularly relate to capacity in this area but rather all capacity in general practice. The country is quite short of general practitioners and very short of practice nurses. It is a capacity rather than skills problem. It is a relatively straightforward deficit to correct in the context of whole system management.

On the question of whether there is an impact on the GP concerned, we understand that at times this is actually quite stressful for individual GPs. That is reflected in our system of peer-reviewed support, which is largely delivered through the CME network and is run by a series of tutors. It involves a majority of GPs reflecting on a monthly basis. Challenging and problem case management is something that we often discuss, and certainly this area of care is often reflected in those discussions.

Individually, general practitioners can be quite challenged and exercised, and occasionally, almost wounded by the experience. In particular, there are certain situations that all of us who have been in practice for years have come across. The issue of late terminations can be extremely stressful and difficult. General practitioners, by and large, are resilient people and we get on with things as we must.

With respect to the issue of a practitioner who is caring for a person who is eligible for a medical card and who is also a conscientious objector, in theory that could be a problem but in practice we do not see that it is an issue. I suppose it is all right for us to say that in the Irish College of General Practitioners, but in good faith we do not see or understand that this has been a problem for our patients. People rapidly understand the difficulty and gravity of this matter and they move quickly to take appropriate steps. We hope that we are correct in that regard.