Professor Tom O'Dowd:

On the manpower issues, there has been much talk about primary care in both the Sláintecare report and my report. It has been in the media and has filtered through to people so patients now think things are better because they are hearing about it. The hospitals drive GPs mad saying the patient needs a particular test and asking the GP to organise it because they believe he or she has better access than the hospital. It drives GPs mad because we do not have that access. As a result of all the talk going on, the sense on the street is that things have changed and that GPs are better resourced than they were. All it has been is talk; there have been no resources. It has impacted very much on our young colleagues. We spoke to them in this report. I would be very sad if the contract amounted to chronic care bolted on to what we are doing at the moment. They talk about wanting to build a team, better support for patient care and a new career structure. It is a new contract they want, not a revised one. Morale is very brittle. February is resignation month in general practice. One thinks one has gotten over the winter and then something else comes along so it is always a difficult time.

I am more worried about the business basis of general practice. It is unstable. This morning while I am attending at the committee, I put in a locum who will make more than I will for the morning. That is a zombie business. It is what the BMA calls a zombie business. It is not a stable business on which to build anything. Deputy Kelleher is right. It is a paradox that we are trying to develop a new system based on our weakest link. It presents political, medical and other kinds of risk. There is a thing called the primary care paradox, which exists internationally. In order to change the system of care, people are looking at something that is probably the weakest link in the system. It is a profound question.