Dr. Grace O'Malley:

Self-monitoring is part of normal practice that should be done everywhere. The HSE's "Make Every Contact Count" initiative is definitely a welcome one. It would be interesting to examine how GPs are resourced in the Netherlands by comparison with Ireland. As far as I am aware, the current contracts here do not provide for any treatment. That definitely has to be looked at. We cannot expect primary care practitioners to deliver treatment when they are not paid to do so. These patients definitely need to be treated by GPs and public health nurses, but the resourcing to facilitate this has to be guaranteed. There is no point in a family picking up the courage to go to see a GP who might not attach any priority to a patient in respect of whom he or she is not able to be paid. If a family gets a negative response or is not treated with the same dignity or respect that another patient would be treated with, there will be a reduction in that family's interest in attending again. The Senator has mentioned stigmatisation, which is a huge issue. Dr. McGuire will probably want to speak about this. We have done a lot of work on stigmatisation across all of our society, including the Government and the media. We need to have stricter rules on bullying people who are of a different shape. We have rules and laws that prohibit bullying based on gender, race and sexual preference, but nothing of that kind applies to body shape. To me and to my team, it is unacceptable that somebody of a certain shape should be bullied and stigmatised.