Ms Susan Clyne:

The short answer is "yes". To clarify, GPs are, in fact, represented here today through the IMO which has been the negotiating partner on the GMS contract since its inception.

There are issues with the negotiations that are well known. They have been going on for a very long time. Since the time the contract negotiations started, emphasis shifted with the arrival of Sláintecare, although it is unclear to GPs and the public in general as to whether Sláintecare will be implemented despite it having cross-party support.

The IMO was in contract negotiations for all of 2017 and progressed very far around the areas of chronic disease and capacity, which were issues highlighted, both by Professor O'Dowd's report and the Sláintecare, as priorities for general practice. However, it was clear from the budgetary allocation last year of €25 million that that would not be possible. In truth, it is not a question of good faith or otherwise. What is holding up negotiations is the lack of resources.

However, we must be clear, from the IMO's point of view and from all GP members' point of view, that as long as FEMPI is not restored there is no hope of getting new services from general practice because the existing services are not financially viable. There must be a roadmap to restore FEMPI. These are all the issues that drive people to retiring early, practices not getting any applicants and young trainees not working here. The gap of 38% is considerable. Every other public servant and politician has had his or her FEMPI reversed. General practice is out on its own and has had nothing reversed for it. That must happen. It is not viable in any way to say that general practice can take on all this new work while the foundation and the underlying model is not funded properly.

The IMO's position is that there must be a roll-back of FEMPI and then there must be additional funding for any new services that are to be brought in. It is not an either-or issue. It is not that new services can be brought in on the back of FEMPI. That would merely crucify the system. General practitioners are frustrated. Patients of GPs are frustrated. Patients of GPs are now becoming a rare breed because in many counties around the country patients cannot find and enlist with a GP and are resorting to have to go to the out-of-hours service where there is no continuity of care. According to research in the UK, continuity of care saves lives. It is that simple.

We have been before this committee previously on the GP issues and we are happy to return on more GP issues. This meeting today is specifically about general practice. We brought general practice into our presentation in so far as over the long term with proper investment we can reduce hospital admissions and general practice can assist in reducing presentations on the waiting lists.