Dr. Brendan O'Shea:

Senator Ruane asked the very important question of how can we know whether every woman and her partner gets the best care in these circumstances. It is not all right to have fuzzy nice thoughts about that. It is an important question but, to some extent, it is a difficult question to answer with a high level of satisfaction. In general terms the considerations are as follows. We do always pay attention in our activities and focus in on when patients do not get best care in a variety of different care settings. This is a special care setting and it has got an additional complexity around it but it is part of what we do in the college. Quality is built into our key core message and it is the foundation message of the college.

We do understand that patients get suboptimal care if the doctor is unwell so we have an active health and practice programme, run through the ICGP, and have done so for many years. The programme is innovative. We do look to the health of general practitioners to make sure that they are well. If the GP is stressed or anxious he or she is more likely to be peremptory, dismissive, not in good form or otherwise receptive. That is one plank that protects patients.

We have features of practice. We have a practice management programme where patient feedback is built in. As part of that we encourage general practitioners and advise them, as part of good practice, to solicit and ask for feedback from their patients. We recognise that those in this patient group are especially vulnerable. It is difficult to conduct themselves as enfranchised consumers given the experience that they going through. Simple feedback on its own almost certainly is not enough. In the college, during the past year, we have formally sought to see what are the additional ways that we can have patients or, really, people involved in our internal college processes. That is an area that has been highlighted by the college's board. Again, we hope that women and their partners who have gone through this experience may find a voice within college in terms of that. It is important for the integrity of the college.

There are other pieces that are relevant. Again, in all areas of care we are required to conduct practice audit. Certainly, any general practitioner or practice could choose to select audit activity around this area of care. There are a variety of mechanisms but none of them are mandatory or absolutely required. We would hope, given the variety of different options to safeguard patient well-being, that this group of women, despite the criminalisation of abortion, do not particularly get the thin edge of the wedge from the service that we provide.