Can a cure be found for Ireland's dwindling numbers of GPs?
Despite Their Many 50s, Age Opting Gps Being Out Ireland, In Resigning With Are A Faster Are Of In Than Replaced, 70 They Retirement
Our population is at its highest in 200 years and that growth has increased the difficulty in accessing a GP.
It is a challenge not just for people who move to a new area, but even patients who have a doctor are finding it harder to get an appointment, and they include medical-card patients.
The HSE groups medical-card patients together in lists known as GMS, and GPs can apply to run these.
At least 23 lists are under locum doctors, because permanent replacements cannot be found for this state-funded work.
A further three lists are being covered by neighbouring GPs, because even a locum cannot not be found, the HSE said.
This looming crisis appears to be caused by a growing population (that has greater needs in the wake of the pandemic) coming up against doctors leaving the profession at a faster rate than they are being replaced.
Getting an appointment on the same day you call a doctor was assumed in the past, but that is now also under threat and it is this that is affecting the greater number of patients.
Most practices are no longer taking on new patients, the chair of the Southdoc out-of-hours service for Co Cork and Co Kerry said this week.
Dr Joanne Montgomery said patients are coming at night, because they do not have regular GP access.
"In general practice in Ireland, traditionally you'd get seen on the day," Dr Montgomery said. "That is no longer the case. I know in some practices you will be waiting a few weeks for routine appointments."
Dr Montgomery is also a GP at the Douglas Medical Centre and, like other practices, it will see emergencies on the same day, but non-urgent cases may be deferred.
Most GPs treat a mix of private patients and medical-card patients, the latter getting a range of services free.
Figures provided by the nine HSE community healthcare organisations (CHO) show that 2,593 medical-card lists are in operation.
The number of lists covered by locum doctors is likely higher than 32, as some regions count as filled lists that are cared for by GPs on 'short-term vacant posts'.
In region four, covering Co Cork and Co Kerry, a locum is covering the medical-card list for Ballyduff, with a permanent appointment now expected for July.
In the last year, 15 lists linked to doctors resigning or retiring were merged with patients of GPs in that same practice, and two groups of patients were moved to other practices in the region when their own GP retired.
In region five, covering the southeast, five GP practices have locums in place, the regional spokesman said.
During the last year, they merged 15 lists by giving the patients to doctors in the same practice as the doctor leaving, and merged two lists by moving those patients to other practices.
Dungarvan is one of the towns affected by this movement of patients.
Local Sinn Féin councillor Conor McGuinness said one GP is retiring and his patients were moved to other practices, including almost 20km away to Cappoquin.
"In Dungarvan, a lot of people struggle to get an appointment as quickly as in the past: It can take several days, it can take several weeks," he said.
"Doctors are very adept at triaging for emergency situations, but there is a lack of GPs in the system and that is creating waiting times."
Mr McGuinness raised this at the Regional Health Forum, South, recently. In response, the HSE wrote that patients can ask to be reassigned, but there is a three-month waiting period before moving.
Region three, covering Co Clare, Co Limerick, and North Tipperary, has seen 14 GPs retire or resign in the last year. Their patients have been transferred to other doctors, the HSE said.
However, they have placed locums in two Co Clare practices, providing a GP, practice nurse, and secretary while recruitment continues.
Former TD Dr Michael Harty retired in March from his practice in Kilmihil, in Co Clare, and this is believed to be one of those practices.
Before he retired, he told the people were coming from 20km away to see him, as they could not get a GP closer to them, not even in Ennis.
Despite their rural location, none of the 157 medical-card patient lists across Co Donegal, Co Sligo, and Co Leitrim, in region one, are covered by temporary doctors, the HSE said.
Dr Montgomery said there are a number of reasons behind the delays for patients.
"Most GPs would retire at 70, but now people in their 50s are looking for exit strategies. Now it’s younger people looking at that," she said.
"There is a big crisis looming. I think all medical people are very tired after the last couple of years. There is a bit of battle-fatigue and people who wouldn't have thought about retiring are, now."
This can have a knock-on effect on access to out-of-hours care, like Southdoc or Shannondoc.
"This is a real problem," Dr Montgomery said. "It is less of a problem in the city, but it is a much bigger problem in rural areas, where there would be less people on a rota."
She said: "Somewhere like Macroom, there are only nine doctors on the rota, so that means they have to do one in nine week-nights and one in nine weekends, which ends up being more when you count in holidays."
Fermoy and Mitchelstown have 21 doctors on the rota, which offers more flexibility, and city-based doctors would do shorter shifts on a more frequent basis. GPs working out of hours in rural areas roll off that and into their normal hours, Dr Montgomery said.
"That is not enticing," she said.
Changes to recruitment practices are taking place, led by the Irish College of General Practitioners, but the question is whether enough new doctors will be found before the retiree wave really hits and whether or not they stay.