In an Oireachtas Committee debate held earlier this month, Mr Hennessy spoke of the HSE’s commitment to ensuring patients throughout the country have access to appropriate health care.
This, he said, included primary care and general practitioner services.
The 484 primary health care teams in the country — with total staff of 3,100 — ensured there was a dedicated HSE group in each geographical area, working hand in hand with general practitioners (GPs) to service rural areas.
He did admit that primary health care teams were still “a work in progress”, but said over 300 new staff were taken on in the last three years, and with new ideas to take advantage of advances in technology such as “tele-health” (seemingly, a system of expert consultation by video call), the reach of the modern Irish health service was sure to permeate every nook and cranny of rural Ireland.
The group of TDs and Senators present weren’t so sure that this was translating into the same thing on the ground, however.
Deputy Éamonn Ó Cuív wondered just how many of these primary health care centres were actually on the ground in “real” rural Ireland. He couldn’t see much evidence of them replacing the scaled-down local hospitals and closed-down emergency units.
The only pattern evident to him, he said, was that of the vicious cycle of services being withdrawn, leading to population decline which in turn leads to the withdrawal of further services.
One of the key incentives to persuade GPs to locate in remote areas is the Rural Practice Incentive Scheme.
Under this support initiative, a GP setting up in a rural area will receive a stipend of €20,000 per year (recently increased from €16,000) towards the running costs of the office.
Moreover, there are other various incentives available under the scheme, such as an allowance for a nurse and a secretary, maternity cover, etc. According to Pat O’Dowd – Assistant National Director of the HSE, National Contracts Office), the overall package can be worth as much as €45,000 a year to a rural GP’s office.
It isn’t enough, however, to keep doctors in rural areas.
There are numerous cases across the country of GPs retiring and not being replaced by a younger doctor in smaller towns and villages.
In Rathmore in Kerry, for example, it has taken two whole years for a recruitment process to replace the retired GP. There was a time when a village practice like that one would have been snapped up. A claim would have been laid on it long before the outgoing GP was retired.
The problem goes back to the economic crisis, according to Dr Martin Daly, member of the GP Committee of the IMO (Irish Medical Organisation).
He talks of a stop-gap system in place since crisis measures were hastily introduced, that doesn’t reward GPs adequately. He’s a rural GP himself, with a practice in Ballygar, Co Galway.
“Since 2008,” he says, “simply put, GMS [General Medical Services] rates have decreased significantly, while at the same time workloads have increased dramatically. In 2008, 1.4 million patients had a GMS or doctor visit card. This has increased to more than two million.”
At the same time, he says, GPs have had their fees cut by some 38%. While cuts were applied to all public servants at the time, he says, a crucial difference with GPs was that the cuts were made on turnover, as opposed to salary, yet their running costs have remained the same, while their workload increased.
“Many young GPs look at practices and, having done the mathematics, see that they are unviable. They have options elsewhere, within this jurisdiction and overseas, and are emigrating in increasing numbers.”
GPS have survived much better in urban areas, by taking on more private patients, but in rural areas, that opportunity has not been there.