Liam Twomey (Fine Gael)

Senator O'Toole's remarks deserve some debate. To give some indication of the position, this would not affect me greatly. Some ten years ago when I opened my own general practice, the surgery was approximately 1,400 sq. ft. in area. Since then, two extensions have been put in place and it is now approaching 3,000 sq. ft. The rates go up accordingly. The patient practice has not grown correspondingly but much of the works are done to improve the quality of care and the quality of the premises where patients are treated. It is different from the case of consultants in that they use public facilities to see private patients. The Senator is correct that we are using private facilities to give good quality care to public patients but it is the opposite of what is taking place in the hospital sector.

The theory behind the proposal is that we move general practices away from garages or where GPs had extensions on the side of their house, where patients had to queue up in corridors, and where there were privacy issues and issues related to the way in which patients were looked after. There should be treatment rooms where everything related to the way patients are looked after is as modern as possible. The situation has improved dramatically in the past 20 years but the Government policy on primary care is taking this to another level. Our practice has gone from 1,400 sq. ft. to 3,000 sq. ft. over the course of a decade. The centre under discussion in Mallow is 78,000 sq. ft. The average size of these primary care facilities is somewhere between 20,000 sq. ft. and 30,000 sq. ft. They contain HSE staff, diagnostics, proper treatment and waiting rooms, and smaller waiting rooms to treat patients who have illnesses such as gastroenteritis which may otherwise be spread to other waiting patients. It is a dramatic improvement on the way in which patents are looked after in primary care. The Senator is correct to say these are private premises owned by private GPs but they look after public patients within that system. It is true they are paid to look after patients but there would be no difference from the payment I would receive for looking after medical card patients if I never expanded my practice. If I still had patients queuing in the corridors and had substandard facilities, there would be no difference to my payment. My rates bill, insurance bill and every other bill would be down but that is not the way I envisage the direction and ethos of general practice in future. I emphasise it is completely different from the hospitals in the sense that consultants are seeing private patients in a public facility. At issue is the ethos we are trying to promote and the attempt to move health care into primary care and ensure this policy does not collapse under the current economic downturn. These reliefs would benefit all patients, public and private, but even if they did not cover everything, they would dramatically improve the service being provided. Even from an ideological point of view in the provision of health care, I can see this as being positive. From the point of view of cost, I can see that if the Minister had to do a cost benefit analysis, she would also realise this would be beneficial.