Dr. Laura Durcan:

We calculate the figure for restoring pay parity at around €20 million. Therefore, taking it from the agency or locum bill, to get people in posts and have service development for patients, should be better than cost neutral. We are selling the proposal as cost neutral, but we could actually save money on the locum bill, though I am loath to say that before it happens.

It should be possible to balance those.

In rheumatology, dermatology and gastroenterology, we use quite expensive biological drugs which cost a huge amount of money. There has been a HSE initiative to bring on a biologic hub where one electronically prescribes these medications. The HSE has put forward this programme where we prescribe biosimilars, which is similar to the concept of generic prescribing. One prescribes the slightly cheaper version. In return for that, the Government has set out that the units will be rewarded with a once-off payment in order to facilitate this kind of process. The Irish Society of Rheumatology and my hospital will weigh in on this.

The truth, however, is that people want to weigh in in a scenario where they have a good relationship. Rheumatology is full of nice people who want to help but there are other specialties which will kick back against this type of initiative. There are many of my colleagues who do not want to engage in a process where they see a system that is flogging them to death but gives them nothing back. It is undervaluing them and chasing them away. If one has a system where one engages with the lead players to give patients the best service they can have, then it is a relationship that works both ways. There are huge cost savings which we had in many different places. At the moment, however, we are all operating in silos and we think those outside them hate us. We may not be as facilitating as perhaps we could be. That is being honest.