Dr. Pádraig McGarry:

I was going to address that in relation to Deputy O'Reilly's question on chronic disease management. She rightly said that 95% of chronic disease management could and should take place in general practice. There are models out there which have been in existence for the last ten or 12 years, notably Heartwatch and the diabetic midland care model, of which I am part myself. Under those models, the vast majority of cardiac and diabetic patients are monitored on an ongoing basis through preventative care in general practice. A lot of that work is carried out by the practice nurse overseen by general practitioners. Certainly, there is a role. The chronic disease management roll-out needs to be expanded beyond just the diabetes model. The Heartwatch model has been shown to be hugely beneficial for patients by reducing risk factors by up to 50%. That has to be expanded into a multi-morbidity model because there is movement away from single-disease models. We need to look at a multi-morbidity model because the likelihood is that a diabetic patient also has some heart disease and other issues. Rather than to have a single focus, the care model needs to be broadened out. We have actually been doing work on that. We have surveyed our practices to see what workload is involved and we have worked with Professor Brendan McElroy who has experience of the Scottish system's development of such a model. There will be room in that respect for task transfer.