West Cork doctor: 'I fear for the future of general practice'

Dr Fiona Kelly in Castletownbere, West Cork. Multiple efforts to find a locum to provide cover for a single day failed, underlining the shortage of GPs. Picture: Andy Gibson

“I’m so so worried about the future of general practice,” says West Cork doctor, Fiona Kelly.

When the Castletownbere-based GP recently tried to take her first holiday in more than a year, she struggled to get cover and was forced to close her practice for a day. She says she is not alone and that GPs are struggling with the workload due to the crippling shortage of general practitioners nationally.

On a typical day I could have anything from between 70 and 100 patients in my diary.

"That includes face-to-face consults, phone consults, email consults, and text consults,” she said

“But the European Union of GPs and the British Medical Association have recommendations for a safe level of patient contacts per day of not more than 25.”

She stressed: “This is not just me, every GP is doing this.”

Dr Kelly runs one of two GP practices in the busy fishing port of Castletownbere and treats everything from childhood illnesses to pregnancy to wounds suffered by fishermen.

“We are two hours from the nearest trauma centre, obstetrical unit, and surgical unit in Cork,” she said. “It’s a working fish port here, there are loads of injured and sick fishermen, I see it all.”

Dr Kelly began planning her holiday when a retired GP offered to hold the fort. However this doctor realised too late their insurance would run out 24 hours before the end of the agreed period and could only be renewed for one year at a cost of over €6,000.

“My practice manager contacted two locum companies and also put an advertisement on a GP Forum,” Dr Kelly said, of their frantic efforts to find a locum for one day.

“I also made several word-of-mouth enquiries. But alas, all of our efforts were unsuccessful.”

As a result, they temporarily closed the practice on Friday, June 30. “But the minute I closed the door, within half an hour of when we should have opened, I got that email from the HSE wanting me to explain my position,” she said.

Asked about the idea of the HSE employing GPs directly, employment as an option. Fiona Kelly said: 'I would absolutely consider that.' Picture: Andy Gibson

“I was just so disappointed because the service I have provided for the last 14 and a half years, nothing of that is recognised. I got no thanks for taking five weeks’ maternity leave, no thanks for taking four weeks’ maternity leave [with another child], no thanks for working through my daughter’s battle with leukaemia.”

Dr Kelly is not alone in struggling to find cover. The question now for GPs and their patients is how soon can Government funding of €130m announced this week kick in to address the problems. GPs are self-employed but there has been political discussion that the HSE should also offer employment as an option.

“I would absolutely consider that,” she said, adding: “I absolutely love my job, I’m passionate about my area and my patients. I’m so so worried about the future of general practice.”

A HSE spokeswoman said in general; “there are not enough GPs to meet the current and future needs of our expanding and ageing population with highly complex care needs.”

Medical card patients are linked to GPs using GMS lists. Each can have hundreds or thousands of people. When a GP retires or leaves, these patients are allocated other doctors but this is not always possible.

HSE Cork/Kerry Community Healthcare said no GP can be found for Youghal, Co Cork, and similarly in Caherciveen, Co Kerry.

In Cork City, one list is being covered by a locum doctor. The HSE did not say how long this has been the case, but said: “on average, the locum GP cost per three-hour session is €300-€400 per session, with a circa average of 10 sessions per week” indicating a cost of up to €16,000 monthly.

HSE Mid West Community Healthcare said three of their lists are covered by locums, in Kilrush and Lisdoonvarna in Clare and Thurles in Tipperary.

In 2020, the region spent €162,676.25 on locum GPs; €204,277.95 in 2021; €715,769.63 last year, and €255,190.85 so far this year.

Achill Island in Mayo has a vacant GP role since July 2020 despite being advertised 11 times. Locum doctors have filled in, costing HSE Community Healthcare West “in the region of €25,000 per month” or around €900,000 so far. This means Achill, Clare, and Inishbiggle Islands continue to be served by three doctors.

Additional GP training places is one solution. This month, 295 doctors enter training, up from 120 a decade ago, with a plan to reach 350 within three years.

There are 940 GPs in training through the Irish College of General Practitioners now, a HSE spokeswoman said said, adding that a scheme offering non-EU doctors work in rural areas has seen 50 doctors start since early this year, and 50 more are expected by December.

However the Irish Medical Council said while the processing of applications for one route into this scheme takes eight to 12 weeks, another common qualification pathway is challenged.

It is currently taking “30 to 34 weeks” or up to eight and a half months for doctors to have their internships recognised.

“Since the easing of the pandemic, the number of applications coming through this route has increased significantly and the levels remain consistently higher than pre pandemic,” a spokeswoman said. They can no longer “maintain previous turnaround times of 8-12 weeks”, she said.

Kerry GP and clinical director for Southdoc Gary Stack said shortages need to be urgently addressed — especially in light of confirmation this week that free GP access will be expanded.

Some 78,000 children aged six and seven will not be charged appointment fees from August. Up to 470,000 people including their families where income is below €46,000, will also get these GP cards on a phased basis.

The expansion includes a €130m financial package agreed with the Irish Medical Organisation to support doctors and attract new entrants. 

Concerns in Fermoy 

Meanwhile there is concern at potential reductions to out-of-hours GP service in Fermoy.

Concerns have been growing the ‘red-eye' service after 10pm will be removed. 

Labour TD for Cork East Seán Sherlock has written to the HSE CEO Bernard Gloster about this, saying he understands the change could be put in place as soon as this month.

Southdoc’s administrative centre did not respond to queries on Friday. 

However, clinical director Gary Stack said there is “no change in patient access no change in appointment availability and no diminution of service” for that region.