Catherine O’Donohoe: The GP locum crisis is adding to the pressure on our health system
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HSE chief executive Bernard Gloster has taken the rare step this month of cancelling most of the scheduled care in the Mid-West region, across its hospitals in Limerick (UHL, Croom, St John’s), in Clare (Ennis), and in Tipperary (Nenagh).
The duration of this cancellation is uncertain, with Mr Gloster stating that he would like to think that “it’s in the category of weeks”.
He has spoken of his visit to University Hospital Limerick, on the evening of Wednesday, August 9, and how he was “shocked and horrified” at the volume of unscheduled (urgent and emergency) care and that he “could not stand over the situation”.
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It is essential that the challenges facing our hospitals, in delivering care that is scheduled (planned, such as appointments and operations), or unscheduled (urgent/emergency) are not seen as isolated from the challenges in our GP workforce.
Health watchdog Hiqa in its December 2022 report, said: “The shortage of GPs across Ireland has resulted in delayed access to GPs and limited access to practices, as many are unable to take on new patients.
“Consequently, Irish emergency departments may often need to act as a single point of access to healthcare for patients whose needs might be better served by alternative care at their GP or other healthcare services in the community.”
Health Minister Stephen Donnelly announced the terms of reference for the Department of Health Strategic Review of General Practice in April 2023, with the expectation that this review was to be complete in 2023; it is still awaited.
The strategic review had followed on from The Irish College of General Practitioner’s autumn 2022 paper, ‘Shaping the Future of General Practice’. That document had outlined how 600 GPs work in single-handed practices.
It had also reported how “the 2021 ICGP membership survey showed that one-third of GPs in 2021 were unable to take annual leave, due to a lack of GP cover in their practice”.
I suspect that, three years down the road, this situation will not have improved for many GPs and may even have worsened.
Despite the progress made in recent years, it is time to stop and to take stock of where exactly we are as regards a GP trying to secure locum cover, whether to take leave or due to some other reason.
The daily State subsidy for a locum is €197.24 in 2024, up to a maximum of €1,380.65 weekly.
This is less than a €100 increase from 2004, when the weekly maximum was €1,299.02.
Twenty years ago might seem like yesterday to some of us but, in 2004, our present Tánaiste, Micheál Martin, was minister for health and there have been six health ministers since.
As an individual GP, I respectfully suggest that the time has passed for the minister and the Department of Health to be allowing the GP locum crisis to continue.
Just as Mr Gloster outlined his concerns about what he saw on his visit this month to UHL is not sustainable, and not excusable, it needs to be understood that the GP locum situation is not tenable, either.
This situation simply cannot continue. The Irish Hospital Consultants Association understandably asked last week:
Our GP locum crisis affects every county, but it is more obvious in rural than in urban areas, and it is all year round. It is not a seasonal problem. It remains impossible in so many places for people to register with a GP.
The significance of GPs being unable to get locum cover for any leave — whether it be annual or for illness or bereavement (and even possibly maternity) — must not be underestimated.
The Irish Medical Organisation’s pre-2024 budget submission outlined how our over-65 population increased by nearly 200,000 between 2013 and 2022 and that further increases are projectedto continue in the coming years and decades. This is not a time to keep running the risk of losing GPs, who, more than four years after the start of the Covid-19 pandemic, may understandably feel that they can no longer hold out on being able to get locum cover for their practices.
As GPs, we hold a duty of care to our patients. This is, of course, also a statutory duty.
It is long overdue that the stakeholder decision-makers address the locum GP crisis. Will we see it addressed this autumn, on this Government’s watch, before the 33rd Dáil draws to a close?
Or will this prove, yet again, to be a rhetorical question?
• Catherine O’Donohoe is a single-handed GP in Adamstown, Co Wexford. She is a member of the ICGP and the IMO. This article is written in a personal capacity.