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

I will go first and then it can be decided. I thank the witnesses for coming in and for all the information they have provided. I was a member of the Committee on the Future of Healthcare and we would have felt the loss of the witnesses' input because it is very helpful to hear from people who are actually delivering the services. It is all very well for us to imagine what it might look like but it is quite another thing to hear from the experts.

I have a number of questions. The recent resignation of Richard Corbridge, or his moving on, is a huge blow in the context of the development of information technology. It often struck me when I represented people in the health services that the higher up the chain one reached in terms of management, the farther away one got from the patient and the more one was to encounter the use of BlackBerrys, as was, iPads or some other forms of mobile electronic devices. It is really sadly lacking. Perhaps the witnesses could expand on what exactly would be needed in terms of information technology?

We do not want to get ahead of ourselves, but just bring us up to what would be considered basic in more advanced information technology. The people who should have access to this technology are those who are operating within and move about the community. The witnesses might give us a flavour of how much access there is and what can be done. Who needs to have access to mobile information technology? How would that work? I am thinking in terms of access to near-patient testing and other things that might actually help in the delivery of health care. It did often strike me that the higher up one went and the farther one got away from the patient, the more likely one was to see technology in use. It was a kind of a reward as opposed to something to be used in a practical sense.

There are health care professionals who have to use their own electronic devices, which is not acceptable. What improvements can be made in this area and what would it take to achieve them?

In regard to the breakdown of the fee structure, we see the large sums making the headlines in the newspapers, the Dr. X whose practice received X amount of money. Will the delegates explain what makes up GP income, which percentage is from fee-per-item income and which percentage is from GMS income? I appreciate that the ratios will vary from practice to practice but a guideline breakdown would be helpful. The large sums will always hit the headlines but representative organisations tell us that the income from the State by no means amounts to a bonanza. Where there is a fee-per-item structure, how much of that work is done directly by the GP, how much by the practice nurse and how is all of that remunerated?

Reference was made to the interaction between GPs and primary care teams, allied health professionals and others delivering services in the community. In practice, those interactions are not usually managed by the GP. Are GPs willing to manage that service more closely or is it the witnesses' view that the two arms should function separately? I am asking about what their preference would be in an ideal world. Should we have an independent general practitioner model and, ancillary to that, allied health professionals providing additional primary care services? I understand there is huge frustration among GPs at the difficulties in accessing therapy and other specialist services for patients. Might that problem be resolved by bringing those services under the remit of GPs or is it more a question of enhancing communication between the GP on the front line and the broader HSE service provision?

I have spoken to people who say we are about to see an influx of multinationals into the provision of GP services. We could sit here all day and detail all the reasons that the relationship between patient and local GP is a positive thing, where the doctor knows the person's history and family and is himself or herself a member of the community. People who are cheerleading for an increased input by multinational service providers, of whom I am not one, argue that it will solve the problem of a difficulty in accessing GPs in rural areas and areas of deprivation. I am not convinced of that but am interested in the delegates' view.

I am sure the witnesses are aware of my view on GP salaries, just as I am familiar with their position. There was talk in the media in recent months about the prospect of some form of industrial action. I fully appreciate, as someone who practised in that area, of the challenges involved in advocating for the rights of workers in a particular sector. What we are hearing is that there is an issue not only in regard to recruitment and retention, which is undeniable, but also in terms of the morale of the GPs providing the services. Will the delegates comment on that?

On the GP contract, we are not asking our guests to negotiate it here with us or, indeed, to give away any negotiating position they might have adopted. We often note in this committee that every question we ask of the Department of Health regarding primary care and GP services is met with the response that the outcome of negotiations is awaited, after which every problem will be fixed. I do not know how good the GP contract will be but it seems unlikely to solve every problem that has ever existed in primary care. Will the delegates give us an idea of when they see the negotiations coming to some sort of conclusion? I am not the only person in this committee or in the Oireachtas who is frustrated at the lack of progress, which is not to say that both sides are not working hard to move things along. It seems, however, that a great deal of stuff has been put on hold pending agreement on GP contracts.