Dr. Brendan O'Shea:

This is the inverse care law at work. There was a question on deprivation weightings which we did not address. We can wait for as long as we like for the new general practice contract - and I do not know if it will ever happen - but in the current system the same payment is involved for one of Dr. O'Brien's affluent cases in Castleknock and one of his or Dr. McGinnity's medical card patients in Mulhuddart. A mechanism exists, at the flick of a switch in GMS under the primary care reimbursement system, to put in community deprivation weightings. The HSE has the technology to do that and it can use Health Atlas Ireland for this as it has information about background levels of deprivation in communities and can map the pre-existing resources. When they do this, all the places like Mulhuddart light up so without any new contract they could crank up the payment level and Dr. McGinnity would get €227 per year for looking after a medical card patient, rather than the current €156 per year. I refer the committee to the work of our colleagues of the Dublin Deep End group, which is a group of GPs including Dr. McGinnity and Professor Susan Smith, for more information about this. Deprivation weightings would be very easy to switch on without a new contract if we had the will to do it.

Actions could be taken to ensure more practice nurses and GPs. We fully subscribe to the idea of connectedness in the middle and bottom part of the pyramid and the general practice sector will move rapidly in this respect, though we have doubts about the ability of the HSE to move rapidly on anything.