Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

My apologies, as I was absent for a few minutes. Needs must. I welcome the witnesses. I do not wish to go over the previous questions in too much detail but I am a great believer in having local knowledge on each subject on the basis that it represents a microcosm of the total picture. From the point of view of both organisations, what do they see as the main points in terms of challenging their ability to deliver what is required in the provision of primary care in both urban and rural settings?

Reference has already been made to the GP contract. I am aware the witnesses have some reservations, but not as many as I have, about primary care centres. How valuable are they in the system, taking into account the considerable capital investment involved? They are supposed to cater for a population of approximately 50,000. Some of them appear to me to be like small hospitals. Are they effectively intercepting the patient before he or she has to queue up at an accident and emergency department or he or she becomes a day patient?

People become ill on a 24-7 basis and on continuity and the pooling of cover, in particular out of hours and at weekends, have we yet achieved the ultimate in terms of providing the required cover for patients or do they have to go to accident and emergency departments, with obvious consequences?

A number of GP practices have received a lot of attention, particularly throughout rural Ireland, over recent years. To what extent has the negative comment impacted on the attractiveness of the practice to newly qualified doctors, and nurses for that matter? Do the witnesses see a particular way of dealing with the requirements of rural Ireland, which are distinct and different from those of the rest of the country, without necessarily going overboard spending hard-won money that we do not have? Good organisation is the key to any business, be it in the public or private sector. Good organisations means how the job can be done best and most efficiently in terms of the turnover of patients in the respective practice areas. What are the issues that curtail GPs' ability to deal with those quickly, effectively and in a way that lends itself to enhancing the role of the GP, because everything is critical nowadays? Everything that everyone in the public sector does is criticised. Sometimes this is legitimate but there is a tendency in the goldfish bowl to be overly conclusive regarding the issues.

From a delivery perspective, what are the witnesses' experiences as deliverers of service to the community? What are their experiences in terms of how they see it, apart from the GP contract and other things that need to be dealt with? What do the witnesses see as coming from the patients? What is the most common criticism they get from patients? I know that in our businesses, our patients do not take long in telling us what we should be doing at various times and how we could do better. This is a good thing. That is fine. To what extent do the witnesses get that flow of information from the base in which they work, and how do they respond?

Based on their own experiences in dealing with an individual patient at any time, be it an acute condition or a long-term illness, how do the witnesses see their practices affected by the place to which they refer their patient in the event of the need for referral? For example, can they be sure of the outcome when they refer a patient to a consultant or hospital accident and emergency department? What is the outcome? Is it quick enough? Is it effective? Do they see that patient again? This is the kind of thing we need to know about. I am saying this with tongue in cheek because we get the same queries ourselves. We do not deal with them medically but we try to deal with them in the best way we can. It does not always work either. The point I want to emphasise is that unless we can find a streamlined system that provides in an uninterrupted way a stream of services to the various types of patients who present themselves, we are wasting our time and money. If we cannot do that, we are wasting our money and will not solve it by providing more money. We will just complicate it further. In particular, we can start at the bottom, provide primary care to the best standard we can and then find out the challenges after that, where we are going, where there is congestion and what happens when a GP refers a patient.

All of us in this business know about my last point. There are many patients on waiting lists for various treatments, including elective procedures, or to see consultants. We go through the procedure ourselves. There is a presumption in some parts that, effectively, we are trying to help a patient jump the list. I have never wanted any patient to be able to jump the list but I want a patient who is ahead of another patient to get ahead in order that the second patient can be dealt and we have continuity of effective action and service.