Dr. Peadar Gilligan:

That no patient should be impoverished because of health related issues and that there should be ready access to care is correct. Our anxiety is around the removal of €600 million from the health service. The point was made that private insurance subsidising public hospitals is not sustainable. Without the income they receive from the insurance companies for the care they provide to patients privately, public hospitals would be very challenged in continuing to provide care. The budgetary allocations to hospitals changes year on year. There were many years when the certainty was that the budget would be less than it was the previous year, despite the fact that there had been an overspend in the preceding year. Hospitals are reliant on the money they get from patients treated privately within the hospital system. We would need to be very reassured that this is going to be fully replaced and that hospitals will have a reliable and appropriate budgetary allocation for the work they undertake.

The Chairman also asked if the ability to augment income is an incentive to people returning to consultant posts in Ireland. It is most definitely an incentive. Would addressing the issue of the discrimination visited upon consultants since 2012 help us to recruit? It would definitely help. Until we address it, we will not be able to recruit the numbers that we need. On the case study which was brought to our attention regarding the patient with the clinical conundrum of pyelonephritis or renal stones, that is an issue that emergency departments around the country deal with on a daily basis and can deal with very effectively between history examination investigations and appropriate imaging. We would generally refer the patient on to a urology colleague or a surgeon with a special interest in that area.

The reason alternate routes are being sought for managing that patient is that we as a nation have treated for too long our emergency departments as holding bays for patients who need to be in hospital wards. That is the reason we are all here today. We are here to try to address the overcrowding issue. I can assure the committee emergency physicians can help make that diagnosis readily and help treat that patient readily.

As to whether GP colleagues are being frustrated around the country by an apparent lack of engagement, I would say that our GP colleagues provide a significant level of care. There are 20 million patient interactions by our GP colleagues in Ireland annually. They provide a significant level of service. They deal with the vast majority of patients within their own surgeries or on home visits. It is a small percentage of patients that they send on to the hospital system where they need our care and where they need the capacity within the system. Of course, they work extremely well with community intervention teams and with public health nurses, and, indeed, with their own practice nurses as well, to provide a high level of care.

I will hand over to Ms Clyne to address the question of whether they are frustrated by the lack of progress on contract talks but I think "yes" is the answer.