Why is there a GP famine?

Recent national media reported an increasing shortage of GP’s across Ireland. Indeed, the Irish College of General Practitioners (ICGP) has warned about this fact for quite a while. Existing elderly and vulnerable patients are and will increasingly find themselves without a GP as retirements occur. This also affects a lot of young families in every county in Ireland. Why has it all come to this?

This problem was not hard to anticipate. Ireland has 68 GP’s per 100,000 population, compared to 110 in Canada, and 120 in Australia. We have an ageing GP profession- the average age of GPs in Ireland is 59. It is believed that 660 GP’s are due to retire in the near future. The problem is only going to get worse. So where will the new GP’s come from?

From Ireland? I think not. Irish GP training schemes provide on average 200 new GP’s per year. Of newly qualified GP’s it has been found that only about 80% intend to stay in Ireland. On top of this only about 50% of these GP’s have intimated that they want to work fulltime. For rural areas the problem is more acute. Single handed GP’s are at the heart of these communities. However, only 2% of new GP’s intend to set up a single- handed Practice,

Why do we not retain more of our GP’s? There are many reasons for this.

GP’s in Ireland are effectively self-employed. We are trained to manage medical problems and generally don’t want to have the extra responsibility of managing staff, costs, premises, equipment, generating your own pension etc. In other countries you are a state employee. As a state employee in other countries, if these issues are not looked after for you, they are properly resourced ie significantly state supported.

Secondly, our GP contract with the HSE originates from 1970! It was designed mainly to only support GP’s to look after patients when they become sick. No support for preventing sickness! Only for treating it when it actually presents. In 2019, modern healthcare focuses on preventing illness in the first instance. When this is not supported by your GP contract, many Doctors find life as a GP professionally unsatisfying.

The wider healthcare system also scares new GP’s. It is professionally terrifying to see that your patient’s waiting time for an urgent investigation may be up to 3 months. In the UK, the waiting time for a lot of urgent problems is only 2 weeks. Our health system in these cases is dangerous and this deters new GP’s.

Thirdly, there is a lack of a defined career path for newly qualified GP’s. When you qualify you have two options- set up your own Practice or join a group Practice. Only 2 per cent of Doctors want to set up their own Practice due to the reasons mentioned above. That leaves group practice. But to be allowed to look after pubic medical card patients in a group practice, there is an old culture which suggests you should have to pay the existing Partners a significant sum of money before being allowed to join. This undefined career path deters a lot of Doctors.

Unfortunately, there is no solution in sight. There is a new GP contract being negotiated but it is felt that it is not being thought of as a tool to make General Practice more attractive to new GP’s. This makes it fundamentally flawed. Our biggest problem is the fact that we won’t be able to  get new Irish trained GP’s to take over from the many GP’s due to retire. This means we will probably have to look abroad for replacement GP’s in the future.

And then there is “Slaintecare”. This is the new cross-party vision for healthcare in Ireland for the next 10 years. Currently Ireland spends 4% of its healthcare budget on General Practice. To shift the focus to preventative medicine and to keep patients out of expensive Hospitals, most international experts recommend spending closer to 10% of your healthcare budget on General Practice. If “Slaintecare” is realised, it is doubtful that it will spend money in this way,

When announced this plan had an implied commencement in 2019. But in the HSE Service Plan for 2019, there are no funds allocated for “Slaintecare” this year! More delays! And the “GP famine” worsens.