Dr. Pádraig McGarry:

Senator Colm Burke asked whether any element of the contract could be implemented in the morning. We have gone a long way towards addressing many of the components that require the first phase of a contract. The chronic disease programme, which involves chronic disease management by GPs in the community, is probably central to that. Every time we try to address one issue, another issue comes up and suddenly a whole raft of issues have to run in parallel. The ability to recruit practice nurses has to be developed. That, in itself, raises employment and contract issues that need to be addressed if we are to attract practice nurses into the service. The capacity to have more GPs in the service has to be developed. That brings resource implications with it.

There are other issues in the first phase with palliative care, medical management and special types of services that could be implemented. We have not yet really seen a recognition of the resources that are required for that. All of these things can be done if the resources are acquired. Unfortunately, the budget provides that just €25 million will be made available for primary care in 2018. If those who are negotiating feel there is no genuine interest in going forward, it knocks the heart out of them. Realistic resources need to be made available. I do not doubt that an indication that realistic resources are to be allocated would result in many of these issues coming together. They cannot be done in isolation.

I would like to make a point about one aspect of rural practice. Many people have indicated that they do not want to commit to rural practice.