Along the main thoroughfare in Drumcondra, Dublin, stands a red-bricked Victorian house that was once a family home but now operates as Drumcondra Medical.
The practice, run by husband-and-wife team Dr Brian King and Dr Sinéad Cronin, serves a densely populated community in the capital’s northside. They took over the busy centre during the pandemic, but it was previously the home of one of their predecessors.
“In 1982, he put a plaque on the door and opened as a GP with his family living in the building,” said Dr King. “As they expanded over the years to 1985, they realised they couldn’t do both, so he moved out and the building that was his original home is now our practice.
“That was the classic GP. It was generally a him, unfortunately. You operated out of a house, your sittingroom, your garage or whatever you had.”
RM Block
Moving general practice out of the family home is not the only change in the sector; it has undergone a significant transformation over the last four decades.
In Drumcondra Medical, the physical set-up has been renovated. The couple, who have three young children, increased office space and clinical rooms to enable them to increase the number of nurses and doctors they can hire.
“We have computerised and modernised,” said Dr King. “We’ve improved how we use it, improved our booking system. We’ve introduced the ability to order prescriptions through the website. We’ve made it a bit more technologically savvy for the 21st century.”
Previously, the GP sector comprised predominantly men. They worked from dawn until dusk, mostly by themselves in single-handed practices. They attended patients in the middle of the night when their phone rang for an emergency callout. They rarely, if ever, took annual leave. But this is all changing.
Dr Cronin has recently returned from maternity leave, something that would have been impossible for many GPs in the past. They describe themselves as “lucky” that they were able to find a locum to provide cover so she could take the time off.
“Our generation is getting better at knowing the line between work and home,” said Dr Cronin. “We will say, ‘when I’m done, I’m done’. But the practicality of setting up your surgery to facilitate that is very tricky.
“This week, two of our kids are starting school. We spent all summer planning for it. There are weeks of planning . . . that simply allows me to be at the school gate. That’s why the days of the single-handed GP practices are out the window.”
The HSE GP contract for medical card patients, known as a GMS (General Medical Scheme) contract, dates back to the 1970s and refers to doctors only as “he” or “him”.
The Department of Health is conducting a strategic review into general practice that is due to be completed this year. It is examining GP contracts, among other issues.
But the sole use of masculine pronouns doesn’t reflect what those in the sector have dubbed the “feminisation of general practice”.
A workforce intelligence report from the Irish Medical Council, the regulator, found female doctors constituted 52.4 per cent of the GP workforce in 2024. The majority of single-handed practices, out-of-hours and locum positions were men.
“Therefore, understanding and examining the female GP workforce and their career choices is crucial to planning a sustainable future medical workforce,” the council said.
Dr Suzanne Kelly, a GP based in Ballincollig, Co Cork, says the demands of the current contract, which requires doctors to be available five days a week, “goes against women in the workplace”.
However, Dr Kelly says because the contract states you or a “nominated individual” – meaning another doctor – must be available, many women are banding together to share the workload.
“So the workaround a lot of women use is to take on a GMS contract, keep the number [of patients] a little lower and then, between two or three of you, you have someone there,” she said.
That’s how Dr Kelly and her two other partners operate their practice. She added: “Each of us have smaller GMS lists so only two of us have to be there per day. It’s very manageable and the patients still have a doctor available Monday to Friday.”
While many office jobs provide flexibility if an employee needs to pop out for a medical appointment or a parent-teacher meeting, a patient-facing job does not provide such an option.
“Nothing slots into it neatly,” she said. “We tell people they’re 15-minute appointments, but we’ve no idea what they’re going to tell us. They could have had a miscarriage, they could be revealing they’re experiencing domestic violence for the first time ever. You can’t say ‘sorry Mary, now is not a good time for me’.”
A work-life balance is something this generation of GPs is particularly conscious about, according to Dr Diarmuid Quinlan, medical director of the Irish College of General Practitioners (ICGP). One of the biggest differences in relation to this is how out-of-hours services are provided.
Dr Quinlan said: “When I first came back from overseas in the late 1990s, GPs provided their own out-of-hours cover. You would get a call at 2 or 3am. And that has an impact on patients the next day, because you were wrecked.”
Nowadays, many GPs band together to form co-ops so they can share the burden of providing out-of-hours services to patients in the area.
“They provide uniform, high-quality accessible care,” he added. “It means you do your work in the practice, but we’re no longer getting out of bed in the middle of the night, because that’s not safe.
“That’s a big improvement because it means patients get a doctor in the middle of the night who is fresh and who hasn’t been working all day.”
Not only does general practice now have more women than ever before, there is also an increasing number of international doctors. Nowadays, 40 per cent of GP trainees obtained their undergraduate degree internationally, according to the ICGP.
In 2022, the ICGP launched the International Medical Graduate (IMG) programme for rural doctors. Under this programme, experienced IMG GPs can work in routine, daytime Irish general practice for two years, with some GP out-of-hours work.
Dr Shaegheh Mohammadi, who goes by Dr Shaika locally, is one such IMG participant. She has just completed her two-year programme working with Dr Pat Harrold in Nenagh, Co Tipperary.
The Iranian woman came to Ireland for a course in 2019, “completely fell in love with the country” and decided she wanted to move here. In 2023, she was accepted on to the IMG programme, having worked as a GP in her home country for about eight years.
“In Iran, you work in a rural area and you need to manage a broad range of cases,” she said. “You need to do a lot. So I have a lot of experience and confidence to manage people in rural areas.
“I can bring my experience to the system. It fills gaps in Irish healthcare with wide-ranging, diverse and international experience.”
The State is moving towards bigger practices. GPs are coming together to share the workload to ensure there is cover and they are able to take time off.
But in rural areas, many single-handed practices remain. Dr Amjad Ahmed runs a GP practice by himself in Lahardane, Co Mayo.
Originally from Iraq, the 37-year-old took up the job about 18 months ago after concerns were raised that the village would be left without its own practice. He loves the role, but it comes with challenges.
“Obviously I can’t say it’s an easy job; you’re single-handed, so you’re working Monday to Friday all week,” said Dr Ahmed. “You might be doing out of hours as well. But it depends on your network of people you know.
“For me, personally, I have a few friends who are GPs, sometimes they help me if I need to go away. I am lucky in that way, I think. Not many people will have that as an option.”
He welcomes a recently announced initiative that assists with finding a locum GP so those in single-handed practices in rural areas can take annual leave, describing it as a “lifeline”.
“In the future, I wouldn’t mind having a colleague who helps on a regular basis or part-time basis or perhaps enter into a partnership that will help the practice grow as well,” he said. “I think our generation now is trying not to work full-time, all the time and have some support around to help with workload.”
