Ms Susan Clyne:

Whether they go to a primary care centre or a centre of another kind will make no difference to younger GPs trying to establish themselves. They will still have to pay the rent and all the associated overheads. That does not really help matters. If the HSE is going to invest in primary care centres I urge it to act in consultation with GPs in the area. There is little point in building a brand spanking new primary care centre if ten GPs have already built centres in the area. That would simply be a waste of resources.

Whatever about current GPs and older GPs, who are used to being on a 24-7 contract, young GPs will simply not accept that general medical services, GMS, contract. Nobody is going to accept a contract under which they have to be available all day, every day. To a large extent, GPs fund out-of-hours services from their own resources. Out-of-hours services face problems throughout the country. They are getting busier and busier, particularly in these times. We need to separate the issue of funding for out-of-hours services. That should not be the responsibility of GPs. Responsibilities are much heavier in more rural areas, which disincentivises younger GPs from establishing themselves there. We need to look at ways to help GPs establish themselves financially over a period of time. They need some income certainty in that period of time. We also need to help existing GPs who are going to retire to take on these younger GPs and transfer practices with reasonable financial models. We need to grapple with the out-of-hours system. It is absolutely ridiculous that GPs are expected to pay for locums to work red-eye shifts. Most GPs work until 8 p.m. or 10 p.m. on the out-of-hours rota. The red-eye shift from 8 p.m. to 8 a.m. is effectively funded by GPs themselves. A 24-7 contract is not sustainable.

I thank Ms Clyne.

My next question is for Professor Irvine. The year 2012 was a different world, and whatever justification was there at the time, and there were plenty of justifications, I do agree that it is time to look again at that. I will certainly advocate on behalf of the Irish Hospital Consultants Association. Professor Irvine has comparatives to the pre-2012 salaries for Australia, Canada and the US. How does the public-private model fit in there around consultants working in the private sector as well, or is that excluded under those jurisdictions?