Can a cure be found for the dwindling number of GPs in Ireland?

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Our population is at its highest level for 200 years and this growth has increased the difficulty of accessing a GP.

This is a challenge not only for people moving to a new area, but even patients who have a doctor have a harder time getting an appointment, and that includes patients with medical cards.

The HSE groups patients with medical cards into lists called GMS, and GPs can apply to run them.

At least 23 rosters are under locum physicians because permanent replacements cannot be found for this publicly funded work.

Three other rosters are covered by neighboring GPs as even a substitute cannot be found, the HSE said.

This impending crisis appears to be caused by a growing population (which has greater needs as a result of the pandemic) encountering doctors leaving faster than they are being replaced.

Getting an appointment the same day you call a doctor was supposed in the past, but this is now also under threat and is what affects the greatest number of patients.

Most practices are no longer taking new patients, the chairman of Southdoc’s on-call service for Co Cork and Co Kerry said this week.

Dr Joanne Montgomery said patients came at night because they did not have regular access to a GP.

“It’s a huge crisis, and it’s hard to know where it will take us.”

“In general practice in Ireland, traditionally you’re born,” said Dr Montgomery. “That is no longer the case. I know in some practices you will wait a few weeks for routine appointments.”

Dr. Montgomery is also a general practitioner at the Douglas Medical Center and like other practices, he will see emergencies the same day, but non-emergency cases can be rescheduled.

Most GPs treat a mix of private and medical card patients, with the latter receiving a range of free services.

Figures provided by the HSE’s nine Community Health Organizations (CHOs) show that 2,593 medical card lists are up and running.

The number of rosters covered by locum doctors is likely to be over 32, as some regions count as filled rosters that are taken over by GPs on ‘short-term vacancies’.

In region four, covering Co Cork and Co Kerry, a replacement covers the medical card list for Ballyduff, with a permanent appointment now scheduled for July.

Last year, 15 lists linked to resigning or retiring doctors were merged with patients of GPs from that same practice, and two groups of patients were moved to other practices in the region when their own doctor GP retired.

In Region Five, covering the southeast, five GP practices have introduced locums, the regional spokesperson said.

In the past year, they have merged 15 lists by assigning patients to physicians in the same practice as the departing physician, and merged two lists by moving those patients to other practices.

Dungarvan is one of the towns affected by this movement of patients.

Sinn Féin local councilor Conor McGuinness said a GP was retiring and his patients had been transferred to other practices, including nearly 20km from Cappoquin.

“In Dungarvan, a lot of people are struggling to get an appointment as quickly as they used to: it can take days, it can take weeks,” he said.

“Doctors are very good at triaging emergencies, but there’s a lack of GPs in the system and that’s creating wait times.”

Mr. McGuinness raised this issue at the Southern Regional Health Forum recently. In response, the HSE wrote that patients can apply 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 over the past 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, a nurse practitioner and a secretary while recruitment continues.

Former TD Dr Michael Harty retired in March from his practice in Kilmihil, County Clare, and is believed to be one such practice.

Before retiring, he told the Irish Examiner people came from 20km to see it, because they couldn’t get close to them, not even in Ennis.

Despite their rural location, none of the 157 medical card patient lists in Co Donegal, Co Sligo and Co Leitrim in the first region are covered by temporary doctors, the HSE said.

Dr Montgomery said there were 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 this,” she said.

“There’s a big crisis looming. I think all the doctors are very tired after the last two years. There’s a bit of battle fatigue and people who wouldn’t have considered retiring are. now.”

This can have a ripple effect on access to out-of-hours care, such as Southdoc or Shannondoc.

“It’s a real problem,” said Dr. Montgomery. “It’s less of a problem in the city, but it’s a much bigger problem in rural areas, where there would be fewer people on rotation.”

She said: “Somewhere like Macroom there are only nine doctors on the rotation, which means they have to do one in nine on weeknights and one in nine on weekends, which ends up by being more if we count the holidays.”

Fermoy and Mitchelstown have 21 doctors on rotation, which provides more flexibility, and city-based doctors would work shorter and more frequent shifts. GPs working out of hours in rural areas are switching to their normal hours, Dr Montgomery said.

“It’s not enticing,” she said.

Changes are underway in recruitment practices, led by the Irish College of General Practitioners, but the question is whether enough new doctors will be found before the wave of retirees really hits and whether or not they stay .

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