Dr. Ray Walley:

Senator Colm Burke asked about Scotland. For the past 20 years, 8% of the budget there has gone to general practice and 10% has gone to community care. It has had chronic care programmes and infrastructure supports in place. The problem is that Scotland is coming from a different position. It has a modern-day contract. The Scottish system is outside the UK system. This self-management allowed the Scottish authorities to discontinue tasks like quality and outcomes frameworks, QOFs, which were box-ticking exercises that diminished patient care by focusing on spreadsheets. They changed things. Scotland is a good example, but I am afraid we are not up there. I emphasise that it took 30 years to develop GP community care in the Netherlands and in Scotland. We are in the early throes of that. We need to move on.

Deputy Durkan asked about our priorities. This country has a GP recruitment and retention problem and a resourcing problem. Funding is a big issue, given that just 3.5% of the national budget goes into general practice.

The Deputy also asked about primary care centres. Primary care centres do not see patients. Individuals see patients. We need to focus on GPs and allied health care personnel. They will work virtually anywhere. Shiny new buildings should not be developed unless they are needed. The need for some of them is questionable. New buildings need to be constructed in areas of deprivation and some rural areas, but they should not replace existing buildings if those buildings are adequate.

I will answer the Deputy's question about what we want from the best health care system by saying it was set out in the primary care strategy 14 years ago. We want continuity of care, timely access, accountability, equity of care, efficiency and quality. All of this occurs in general practice, but we can do better. All of this is not occurring in the hospital system, to some extent, because one cannot get into it.

The Deputy also asked about telemedicine, which is being looked at. We all agree on this without even talking about it. Telemedicine involves cherry-picking. In recent weeks, a Cambridge University study showed that telemedicine increases consultation rates because patients' problems are inadequately dealt with. There are examples of good practice in this area. In Norway, a patient can email his or her GP on a public contract in the knowledge that the GP will get back to him or her within five days. That works because it takes the emergency out of it. One cannot deal with an emergency issue on a telephone only. GPs need to have the ability to ask their patients to come to them, or to go to see those patients. That is not what happens under these cherry-picking private set-ups. My colleague, Dr. McGarry, will speak about the contract issue.