Doctor retirement crisis puts patients’ care at risk

Twenty years of not producing enough GPs is coming home to roost and could be disastrous, writes Tadhg Crowley

THE number of GPs due to retire in Ireland over the next 10 years should be a worry to everyone involved in healthcare — particularly patients.

It has been forecast by the Irish Medical Organisation (IMO) that in many counties in the next 10 years, we will have up to 40pc of GPs retiring. So dire is the situation that a campaign, BEAGP [Be a GP], was launched this year.

The campaign enjoyed a successful first year but it is too early to say whether it will continue.

If the campaign fails, the downward spiral could continue. In stark terms, the last 20 years of not producing enough GPs is finally coming home to roost. The problems this will create are important not only for patients left looking for a local doctor but also for overall healthcare in Ireland. Simply put, not having enough GPs is a disaster which could cost lives.

The recent Dail Health Committee report Slaintecare asks for more healthcare activity to be carried out in primary care in the community and, of course, general practice is the cornerstone of that strategy. Without a highly functioning and resourced general practice, primary care fails.

In Ireland, GPs act as gatekeepers. They manage a lot of the activity in the health system. The plan is for them to do more to stop the cost of healthcare in Ireland escalating even further. GPs function well in this regard. The resourcing of general practice has been far lower than its counterpart in the NHS. Satisfaction ratings for the service have been over 90pc in various reports.

This raises more questions. All politicians agree it is a good idea but very few are willing to address the need of resourcing this transfer of a workload worsened by an obesity epidemic, an increase in chronic diseases and an ageing population.

Losing 40pc of GPs will scupper work transfer plans. This work cannot be done by other health professionals, no matter what the reports say. GPs are rapid decision-makers dealing with 90pc of the medical issues outside hospital.

Without general practice, health system costs escalate and the system breaks down. It will mean people in rural Ireland in particular will no longer have the comfort of access to a GP when they need it.

Let’s look at Kilkenny where four out of 10 GPs will retire in the next seven years. In my practice, that will be two GPs. We are a group practice so the effect will be lessened but service will be affected if we can’t hire replacements. Other rural practices in Kilkenny will have to just close and a lifetime of healthcare will stop as soon as the key turns in the lock.

Village life — already on life support by closure of shops, post offices and garda stations — will receive its final push with the closure of the GP surgery. Same-day service almost unheard of in hospital care is the norm in general practice. This is creaking due to increased workload and reduced resourcing of general practice.

That process was started by Financial Emergency Measures in the Public Interest (FEMPI) introduced by Mary Harney and followed up by James Reilly. While some professionals, such as solicitors, had one FEMPI cut, general practice had four. It has never recovered. Cuts of 38pc compared to 20pc of top public civil servants show the disparate nature of the cuts. A short-sighted cut had wide-ranging consequences beyond the myopic bean-counting. It sapped confidence, goodwill and trust among the foot soldiers in health delivery.

Young GPs are emigrating and not coming back. The government up to this year could not fill GP training posts. GP schemes are filled by more women than men (it is mainly men retiring). Being a GP is not family-friendly if you are running your own business. There is a 24/7 contract with the HSE, unheard of in other disciplines. Take in staff issues, stress, building maintenance and you can see why female GPs will run a mile from this.

When I qualified as a GP in 1996, there would’ve been 50 GPs competing for a Medical Card list. Nowadays communities are lucky if one GP applies.

There is a second tier of GPs emigrating. These are GPs in their 50s with huge experience who choose to work abroad — for better pay, better work-life balance or out of frustration at working in a health system that doesn’t respect GPs.

Every week there are GP jobs advertised nationwide which are not being filled.

Further problems for general practice are medical council guidelines, Health Information and Quality Authority (Hiqa) guidelines and the never-ending ‘best practice’ guidelines, produced weekly without any mention of the resources required to carry out these new protocols.

What does this mean to the patient? Well, in rural and urban deprived areas, one would suspect that accessing a GP will be impossible. The next phase of the disintegration is that “same-day service” will be a thing of the past. The increasing workload and lack of GPs will result in more patients attending A&E and hospital services in general.

More admissions will result in increased trolley counts and fewer elective procedures being carried out.

This is not new news, nor indeed fake news. The IMO has been talking about this for years. Politicians have been talking about the need for more primary care centres — but they do not realise that these are just buildings. If there are no GPs to work in them, they will be primary care white elephants — and that will be just another problem rather than a solution.

It is a crisis that the State has never faced before. If we as citizens do not demand action on it, we will be left with a crisis of gargantuan proportions.

The Irish Water debacle brought protesters onto the streets. Money was returned to people who paid the charges after it become a cornerstone of the government formation. Will it take published deaths before healthcare in Ireland becomes an election issue? It will all be too late then.

‘If we do not demand action, we face a crisis of gargantuan proportions’