“I do worry what would happen if I suddenly needed time off,” says Dr Zachary Johnson who runs Drumkeeran medical centre in Co Leitrim with his wife Dr Cassie McVeigh.
“If I suddenly got sick...what would happen to me? What would happen to my patients?” he asks, as he and other doctors from across the country gather at the Irish Medical Organisation annual meeting in Killarney, Co Kerry, this weekend.
The couple are a precious commodity in Irish medicine just now: young general practitioners who have committed to working in a rural setting.
There are GP shortages all across the country. Leitrim, with just 21 GPs, according to the most recent figures, has roughly half the number that doctors’ organisations believe it should have based on its population.
The demands of caring for an ageing population, the provision of out-of-hours services and getting locum cover for absences such as family holidays or illness are some of the issues deterring doctors from filling many vacancies, though there are intensive efforts under way to attract more GPs.
The aim is to have more than twice as many doctors in GP training – some 350 – as eight years ago; recruitment from outside the EU has quickly become an important component in a wider plan.
Two-week delays for routine appointments at some practices and towns losing services as older GPs retire are seen as symptoms of failure by previous policymakers. About one in seven of about 4,500 GPs across the State are approaching retirement.
The total shortfall of GPs stands at about 2,000, with numbers having slipped slightly in recent years as the population climbed substantially. This means significantly more pressure on existing services, with many doctors suggesting they feel they have to work long hours and feel under considerable pressure.
“There a number of different roles within general practice, from seeing patients to medical legal work, and there’s just always stuff that crops up,” said Dr Johnson. “I love the job, I consider myself to be very lucky to provide the sort of care that I feel is important, but I do feel I work too hard.”
Supports to rural practices such as his, he says, are improving but there are issues too, some of them small but significant issues to manage, showing how a small but demanding practice operates.
He cites the example of sending blood samples to his local hospital; this is a task he completes himself most days after the rest of his surgery’s work is done. The hospital recently announced that on Fridays the samples must arrive before 2pm. “That creates a big problem for our practice,” he says.
The availability of locum services is a persistent issue too. A couple of years ago Dr Johnson and his wife booked a family holiday overseas having secured a locum from Pakistan who was going to work a stint in Ireland covering at a number of practices during the summer. At short notice the locum had to cancel as they did not secure the required visa and Dr Johnson had to stay behind.
At last year’s conference he approached Minister for Health Stephen Donnelly about introducing a scheme similar to one in Scotland where locums are centrally employed and made available to practices. Donnelly, he says, was sympathetic, and the IMO and HSE have made provision for a pilot scheme. “That would be a game-changer,” he says.
Kilkenny-based Dr Tadhg Crowley, chair of the IMO’s GP committee, says the issue is just one of the ways in which GPs feel they could be better supported. He recalls heading to Australia to work some years back and the eagerness of local health administrators to take practical measures to keep him and other doctors if they could.
He believes the landscape in Ireland is improving.
“We’re now talking about issues maybe we should have spoken about more than 20 years ago,” he said. “But people are aware that we’re short of doctors, which is good, and I think there is a great awareness now that if you are interested in healthcare being a GP is a lovely job. Ten years ago it was all doom and gloom,” he added, referring to the cuts during the post-crash years.
IMO GP committee member Dr Madeleine Ní Dhálaigh, who is based in Castlerea, Co Roscommon, agrees. “We’re doing really good work. We’re doing meaningful work. The problem is that there just isn’t enough of us which isn’t news to anybody.”
She believes one way in which general practice needs to address the issue is by recognising that the sector now includes many more young female doctors and their concerns need to be addressed.
“A lot more women are doing general practice and with that comes issues like maternity leave,” she said. “We need more flexibility within the GMS [the General Medical Services scheme that covers GP services] so that women are attracted to go in because a lot of the time they fear they won’t be able to practice, that she won’t be able to get protected leave, take maternity leave with her child, and that can be quite daunting.”
All of the GPs that The Irish Times spoke to acknowledge they are affected by wider health service problems such as overcrowding in emergency departments or access to diagnostics at hospitals, increasing the number of patients attending their practices.
“It’s like a three-legged stool and currently all three legs are deficient,” says Dr Crowley. “But I do think now there is a realisation that we need to change.”
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