Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses and apologise for missing their opening statements. We should establish a committee to investigate the development of bi-locatory powers. It might help many members.

A number of problems arise in that we do not have enough capacity, a shortage of GPs and an ageing profile of GPs. We can see from the fact that GPs are leaving that it is not remuneratively attractive. Therefore, we all accept that unwinding FEMPI is critically important. It is an issue that has caused difficulties for GPs throughout the country. In that context, even with the unwinding of FEMPI, are the witnesses completely wedded to the independent contractor model or do they see any role for salaried GPs in the delivery of health care for the public health system?

Consider the difficulties associated with the hospital-centric model, which are evident. All the resources are piled into the hospital and the patients follow the resources. This creates its own difficulties in that there is overcrowding and continual difficulties in trying to get patients seamlessly through the hospital system, either through the emergency departments or scheduled processes. Is there any relationship between GPs, consultants and hospitals? I know the St. Luke's model in Kilkenny is held up as a good example. However, why is there no capability within the health system to have more meaningful relationships between hospitals, consultants and GPs? Sometimes we forget that a GP is a specialist and we end up with specialists referring patients to be seen by a junior doctor who then has to go through the whole process again, although a specialist has already referred them to that point in the health system. We could be forever talking about the grand plans but there are also the small things that mean patients end up in waiting rooms, with junior doctors then referring them off elsewhere. Given a specialist, namely a GP, has already made a referral, there seems to be a consistent delay in moving the patient seamlessly through the process.

Given that we have an ageing profile of GPs, do we need to amend our training programmes to deal with the whole issue of chronic disease and illnesses in the community or are the training programmes which are in place good enough but lacking capacity in terms of throughput? On practice nurses and nurse specialists in the delivery of treatment for chronic disease and illnesses in the primary care centre, how do the witnesses see that involving in the years ahead?

Without putting a tooth in it, in the context of the ongoing negotiations on the GP contract, the witnesses are outside looking in the window. I had and have a view that they should be inside. We are led to believe that there are some forms of informal discussion but I do not know if that continues. However, I would much prefer them to be inside given their organisations represent more GPs than those who are inside. Having said that, will the contract only be finalised when everything is finalised? I assume this contract should be negotiated on a continuing basis. There is this idea that we would wait for it to be completed and then park it up for another 20 years.

Does the witness see any flexibility in that area for picking out quick wins for GPs and, more important, for patients and for the health services? Can those issues which are more difficult to resolve be separated out from it so that we can start the process of implementing Sláintecare's recommendations, primarily in terms of primary care and treatment of the patient in the community care setting?

The witness may have seen the "Prime Time Investigates" programme, and the famous letters that GPs write which say "urgent" or "clinically urgent" which are now deemed meaningless by the system. Where does that leave the witnesses in terms of their clinical competence being questioned by the administration? A GP does not put the word "urgent" on a letter lightly. If there are two patients in his surgery and knows that only one CT scan is available he will obviously give it to the person who requires it most. Have those issues been raised, through the National Association of General Practitioners, NAGP, with the Irish college, to inform the administrative side of the health services that it is questioning clinical and ethical independence?