Dr. Brendan O'Shea:

As that is a contractual matter, I would defer to the expertise of the GP representative organisations, including my colleagues from the IMO. We have spoken about half a dozen different things. It would be nice to be able to reduce the rate of antibiotic use. It would br nice for GPs to go to more primary care team meetings. It would be nice for us to do more multidisciplinary work. We need more bodies if we are to be able to do all of those things. We can do none of them without more bodies.

Electronic communication with patients is a new technology. We are optimistic that there will be an evidence base to prove its efficacy in due course. At the moment, the most likely thing that an electronic consultation will do is furnish an anonymous patient with a doctor who does not know him or her and with a prescription for an antibiotic. That is corporate cherry-picking. The ICGP is committed to researching this. Our view at this point is that telemedicine between specialists, advanced nurse practitioners, GPs and practice nurses could add a layer of efficiency if it is properly resourced. There needs to be a GP in front of the screen. At the moment, GPs are running everywhere.

Deputy Durkan asked a fiendishly cunning question about the negative things that our patients are most likely to say to us. My patients most commonly greet me by telling me it is very hard to get to see me. The next difficulty that is most commonly mentioned is cost. There is ongoing hardship and difficulty, not among the affluent crowd or, arguably, among medical card patients, who enjoy a range of benefits and services, but among the middle people who are squeezed. They do not attend for regular checks. They go off their medications for cost reasons. They agonise. They have rows at reception about the fees we have to charge. As employers, we have obligations to our staff. The negative things we most frequently hear about are time pressures and the out-of-pocket costs that people have to meet. That would be my view in response to the Deputy's excellent question.

On the subject of information technology, reference was made to the national maternity and child electronic medical records scheme in Cork. We have worked closely with the HSE through the national general practice information technology group, which is a good interface between the ICGP and the Department of Health. We are confident that electronic medical records can be rolled out if this group is maintained and resourced. We need to decide to do it. In this day and age, it is too expensive to deliver health care without such technology in place. More of it is needed in primary care and a start needs to be made with it in secondary care. The national maternity and child scheme is a tiny piece of hospital care. We can have no reassurance that there is huge progress to be made in this regard without strong driving from the clinical and legislative sides.