Dr. John O'Brien:

The Senator's second question was on what happens if general practice does not hold up. This is also related to what he said about the distribution of the availability of general practice. As he will be aware, in rural lists the HSE is finding it very difficult to find any doctor to take up the GMS lists. The Senator is right that the distribution of doctors is more favourable in wealthier areas than in poorer areas and that is a very large problem. We are currently dealing with a specific area, namely, abortion, but general practice is comprehensive. It deals with all people and all problems so anything that is causing a failure of general practice will impinge on any discussion, including this one.

Currently, as a country we spend a little bit less than 4% of the national health spend on general practice, which is about half of what the UK provides, and we expect it to be the same. In terms of numbers of GPs per head of population, we have about half of what Australia and Canada have. They would be two popular destinations for GPs who are emigrating. While I am on that subject, we have research with regard to what is happening with our trained GPs, and it now appears that 20% of the GPs who are trained here go away and stay away. We spend a great deal as a country training those GPs and they are leaving for reasons including lifestyle, career progression and the capacity to do what they are trained to do.

I know members are sick of people coming in to say they do not have enough money, and to be honest, I am sick of saying it, but I still draw their attention to the base rate figures which are what percentage of the health spend goes on general practice and what they expect as a result of that. It is impinging upon the new service but it will impinge on every discussion. I have been before the committee for discussions on mental health and it impinges on it in exactly the same way. It is disappointing from our perspective because we feel passionately about the value the general practice provides to people in local communities and day-to-day lives.

To return to the Senator's original question on how it is going to impact and if we have a plan B, I think it is going to impact on the new service. I cannot quantify the impact but, inevitably, what is going on in general practice has to have an impact on the delivery and roll-out of the service.