Keith Swanick (Fianna Fail)
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I apologise for coming and going in order to attend a Commencement debate and the Order of Business in the Seanad. I welcome all the witnesses. Considering all the negatives and pressures on the sector, let me say that, as a GP, I believe that general practice works, and that is solely down to the professionalism of doctors. It is important to acknowledge that. We still have access within 24 hours, unlike our colleagues in the UK.

I totally agree with everything Dr. Flynn said about uncertainty in the sector. There is a perceived dichotomy between the GP seeing patients in his or her surgery and the decision makers, be they politicians or representative bodies. We need to address that perception. I frequently speak to young GPs and medical students; my niece will qualify from the University of Limerick this year. Even though she likes general practice, her main reason for not going into general practice is the uncertainty about funding and the contractual uncertainties. As I have said previously, I fundamentally believe we will not get a good contract without equal status for all negotiating bodies around the table. The NAGP needs to have equal status with the IMO. It is not one organisation against the other; it is about working together.

Our colleagues who appeared earlier today spoke about IT. General practice is so far ahead of the secondary care system in IT. We get blood and radiology test results online. We do referrals online. Much can be learnt from general practice. There is considerable time wasting in the secondary care system. Dr. Ó Tuathail hit the nail on the head. Some outpatient departments are operating with juvenile inexperienced doctors. While we all have to learn, at the end of the day we have to call a spade a spade. People are being brought back to outpatient departments every six months because of the indecision and incapability of a young doctor to make a call. There is a safety net in bringing the patient back six months later. The doctors will have moved on to another job. Those looking at the patient can determine things are not too bad and not much has been missed. That model does not work and will never work. That is why the funding needs to go into primary care where we have senior decision makers who are not afraid to make a call on things and they know their patients very well.

I wish to talk about diagnostics in primary care. Primary care centres are not about the bricks and mortar, but about the activity within those centres. There is no funding model for diagnostics in primary care. I have a DEXA scanner, but the HSE does not pay for medical card patients to have a scan. I have ultrasound and spirometry equipment. It is up to the doctor to provide these services. We need a funding model for diagnostics if we are serious about providing these services for patients in the community.

General practice is a small or medium-sized business with many staff members making up the team, including practice nurses. How would the experts feel about having practice nurses directly employed by the HSE? What about having a different model of funding, involving phlebotomists, for example? We are all doing jobs we should not be doing. Nurses could be doing more productive duties than taking blood.

The drugs saving scheme had ceased before my time as a general practitioner. Would there be any merit in reintroducing that scheme and having a finite spend model whereby the savings incurred would be monitored by the HSE or another overseeing group to prevent it being exploited? I know that scheme was discontinued some time ago, but I would be interested to hear the witnesses' views on it.