Ms Mary Burke:

On Deputy Kelleher's question on access to out-of-hours GP services in nursing homes, unfortunately, the main issue for us is that while a GP will know a patient's history and so on, a Caredoc will not. As stated by Dr. Gregan it is difficult to make a decision in the middle of the night about somebody who is dying. Unfortunately, in some rural parts of Ireland it can take up to 40 minutes or one hour for a Caredoc to get to a facility, during which time the patient is in pain. There is a need to ensure improved access to out-of-hours services and that people at end-of-life stage are treated by GPs with relevant experience in that area. It might be useful to, as suggested by Dr. Gregan, develop a database in this regard.

On the Deputy's question of whether there are sufficient trained prescribers, the answer is there are. There are more than 700 nurse prescribers in Ireland, of which, unfortunately, only 440 are currently practising owing to difficulties in obtaining support in their hospitals. There are only three nurse prescribers in private nursing homes in Ireland, of which I am one. We can prescribe medication but we cannot have it reimbursed under the GMS system. That is the difficulty that arises in the context of the prescription pad. Nursing Homes Ireland, NHI, has lobbied on our behalf for access to such pads.