Dr. Brendan O'Shea:

Deputy Neville raised the FEMPI cuts and asked if everything would be all right if they were reversed. It will not. FEMPI has taken out more than 38% of funding under the medical card system, which has had a profoundly destabilising effect. It must be reversed so practices can begin to recruit more doctors and practice nurses. There is also a need for a contract. The current contract is 39 years old. It is frightening to read it. As our finances have become more squeezed over the past decade, all practices have had to examine everything they are doing in an increasingly tight way and have had to make difficult decisions about what they cannot care for. I do not have time to spend 30 minutes with an adolescent or 45 minutes with somebody who has just had a diagnosis of colonic cancer to explain it. That is causing our younger colleagues, in particular, to feel very bitter and twisted about it. I do not wish to work in a system that is operating so tightly. We are not looking for more money for general practitioners, GPs, and practice nurses. We are looking for more money for more GPs and more practice nurses. There is a difference.

We have some reservations regarding the flat team approach. The primary teams have been set up as a recent example of the flat team approach. They have rotating chairs. It does not work. There is a place for clinical leadership. General practitioners are specialists. We are senior clinicians and the only senior clinicians en massewho are on duty after 6 p.m. any evening. We are community stakeholders. We live in towns and neighbourhoods where we are visible and accountable. We have that continuity aspect. It is not just FEMPI cuts but a better contract.