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

I thank the witnesses for making a presentation. When we hear from people involved in health care delivery in particular, we understand they are taking time out from a very busy schedule to come here to inform us. That is very much appreciated by us.

A couple of issues arise. We have heard already that the management of chronic diseases within the hospital is expensive and cumbersome. The approach is probably not the best.

There is a recruitment and retention crisis. Activity that may or may not be described as industrial action has been discussed and aired in the media. It is an expression of the frustration staff feel at the coalface. When we ask questions about capacity, recruitment, retention and the manner in which these issues might be addressed, we are told continually they will be addressed once the GP contract is sorted. We are told it will be very long, broad-ranging and detailed and that it will possibly fix every single problem in the health service. Perhaps the delegation will talk to us about how we can, even in the short term, address the issue of capacity.

My next question is on the fee structure. What is the breakdown regarding the fee, wages and income of a general practitioner? How is the income divided between the practice nurse and the general practitioner where the two are working together? We have already heard the conditions of the practice nurses described as Victorian. They are working under a very outdated model, with no access to maternity leave and all that goes along with that. I refer to how the work is divided in respect of GMS and private patients and how the income is split. The delegates might talk to us a little about that.

I am interested in hearing the delegates' views on what constitutes a properly fit-for-purpose primary care team. What management do they envisage? Who would be the paymaster and who would schedule the appointments? Who would manage the allied health professionals in that context? How many do we need per head of population? How can we move towards a more fit-for-purpose model?

On the GP contract and the capacity issues, there is a problem not too far from my area owing to medical card patients being turned away and advised they cannot be seen on a Saturday. I am pretty sure that is not an appropriate way to treat patients and that the delegates would not stand over it; nevertheless, it happened. Is that a manifestation of the capacity problems we are having? In light of capacity problems of that nature, perhaps the delegates have a view on how limited capacity is to be managed. If the approach of shutting the doors to certain categories of patients at certain times of the week is the view of even one general practitioner, it is not necessarily appropriate. In Balbriggan, which is in my constituency, there are general practitioners who say they cannot take any more under-sixes. This all comes back to the same issue, that of capacity.

We might hear from the representative of GP trainees as to the mood among that cohort. I am conscious that sometimes when we talk in this room, we are sending a message to people in college that the health service is not an ideal place to work. Clearly, we want general practitioners. They are the brightest and best and they are wanted all over the globe. We know that. They are much sought after. We want to be able to send out a very positive message. Perhaps the representative could talk to us about how we could do that.